Evaluation of Treatment with a single (400mg) versus double dose (800mg) of Tocilizumab in Acute Respiratory Distress Syndrome Associated with COVID-19Pneumonia

Öz

Background: COVID-19 is a viral infectious caused by novel coronavirus called as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent studies have shown that the level of IL-6 in the severe infection group was higher than that in the moderate group, suggesting that IL-6 can be used as a biomarker for severity assessment. However, the correlation of IL-6 levels in critically ill patients is still unknown. Tocilizumab is a monoclonal antibody against the IL-6 receptor and commonly used for cytokine storm or macrophage activation syndrome (MAS) in COVID-19 patients. Objective: In this study, we wanted to compare the clinical outcomes of different doses of tocilizumab (400 mg and 800 mg) as treatment. Methods:In this retrospective analysis we have included 120 patients with mild Acute Respiratory Distress Syndrome (ARDS) associated with COVID-19 pneumonia who received tocilizumab 400 mg once or twice daily. The two treatment groups were compared in terms of age, gender, comorbid diseases, arterial oxygen pressure (PaO2), oxygen saturation (SaO2) on room air, admission to the intensive care, length of stay in the intensive care unit, status of intubation, mortality, C reactive protein, white blood cell count, platelets, neutrophil, lymphocyte, ferritin, D-dimer, procalcitonin levels. Results: There were no statistically significant difference between the two dosing regimens in gender, arterial oxygen pressure (PaO2), oxygen saturation (SaO2) on room air, comorbidities, need for intubation, mortality, requirement for intensive care, total length of hospital stay, length of stay in intensive care, CRP, WBC, platelets, neutrophils, lymphocytes, ferritin, D-dimer and procalcitonin levels. Conclusion : Currently the short and long term adverse effects of tocilizumab have not been clearly reported in the literature. The clinical outcomes of once or twice daily tocilizumab did not differ significantly in terms of efficacy. Therefore a single dose of 400 mg once daily tocilizumab could be a rational treatment option.

Anahtar Kelimeler

• tocilizumab
• coronavirus
• Acute Respiratory Distress syndrome

COVID-19 Pnömonisi ile İlişkili Akut Solunum Sıkıntısı Sendromunda tek doz (400 mg) ve çift doz (800 mg) Tocilizumab ile Tedavinin Değerlendirilmesi

Öz

Arka plan: COVID-19, şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) olarak adlandırılan yeni koronavirüsün neden olduğu viral bir enfeksiyondur. Son çalışmalar, şiddetli enfeksiyon grubundaki IL-6 seviyesinin orta gruptan daha yüksek olduğunu göstermiştir, bu da IL-6'nın şiddet değerlendirmesi için bir biyobelirteç olarak kullanılabileceğini düşündürmektedir. Bununla birlikte, kritik hastalardaki IL-6 düzeylerinin korelasyonu hala bilinmemektedir. Tocilizumab, IL-6 reseptörüne karşı monoklonal bir antikordur ve COVID-19 hastalarında sitokin fırtınası veya makrofaj aktivasyon sendromu (MAS) için yaygın olarak kullanılır. Amaç: Bu çalışmada, tedavi olarak farklı dozlarda tocilizumabın (400 mg ve 800 mg) klinik sonuçlarını karşılaştırmak istedik. Yöntemler: Bu retrospektif analize, günde bir veya iki kez 400 mg tocilizumab alan COVID-19 pnömonisi ile ilişkili hafif Akut Solunum Sıkıntısı Sendromu (ARDS) olan 120 hastayı dahil ettik. İki tedavi grubu yaş, cinsiyet, eşlik eden hastalıklar, arteriyel oksijen basıncı (PaO2), oda havasında oksijen satürasyonu (SaO2), yoğun bakıma yatış, yoğun bakımda kalış süresi, entübasyon durumu açısından karşılaştırıldı. , mortalite, C reaktif protein, beyaz kan hücresi sayısı, trombositler, nötrofil, lenfosit, ferritin, D-dimer, prokalsitonin seviyeleri. Bulgular: Cinsiyet, arteriyel oksijen basıncı (PaO2), oda havasında oksijen satürasyonu (SaO2), komorbiditeler, entübasyon ihtiyacı, mortalite, yoğun bakım gereksinimi, toplam hastanede kalış süresi açısından iki doz rejimi arasında istatistiksel olarak anlamlı bir fark yoktu. , yoğun bakımda kalış süresi, CRP, WBC, trombosit, nötrofil, lenfosit, ferritin, D-dimer ve prokalsitonin düzeyleri. Sonuç : Halihazırda tocilizumabın kısa ve uzun dönem yan etkileri literatürde net olarak bildirilmemiştir. Günde bir veya iki kez tocilizumabın klinik sonuçları, etkinlik açısından önemli ölçüde farklılık göstermedi. Bu nedenle günde bir kez 400 mg'lık tek doz tocilizumab rasyonel bir tedavi seçeneği olabilir.

Anahtar Kelimeler

• tocilizumab
• coronavirus
• Acute Respiratory Distress syndrome

Kaynakça

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