Comparative evaluation of tocilizumab versus high dose methylprednisolonetherapy in mild acute respiratory distress syndrome related to COVID-19pneumonia: a retrospective cohort study

Yıl 2021, Cilt: 2 Sayı: 2, 130 - 135, 15.09.2021

Barış Çil , Mehmet Kabak

Öz

Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) .The underlying causes of severe COVID-19 are related to systemic inflammatory responses that can lead to lung damage. Tocilizumab and high-dose glucocorticoids are practically used in ARDS cases associated with COVID-19.

Corticosteroids are inexpensive and easily available drugs compared to tocilizumab. There is no study comparing these two drugs, which are becoming widely used in treatment-unresponsive COVID-19 pneumonia.In this study, we wanted to compare the beneficial effects of tocilizumab and high-dose methylprednisolone therapy in mild acute respiratory dyspnea syndrome (ARDS) caused by COVID-19.

The study included 152 patients who received two doses of tocilizumab 400 mg or pulsed methylprednisolone therapy (500 mg/day for three days) due to mild ARDS related to COVID-19 pneumonia. The two groups were compared in terms of age, gender, comorbid diseases, hospital stay, admission to intensive care unit, length of stay in the intensive care unit, intubation status, mortality, C-reactive protein (CRP) level, white blood cell (WBC) count, platelet, neutrophil, lymphocyte, ferritin and D-dimer levels.

There was no statistically significant difference between the groups in gender, comorbid diseases, need for intubation, mortality and need for intensive care. There was no statistically significant difference between the groups inage, total length of hospital stay, length of stay in intensive care, CRP, WBC, platelet, neutrophil, lymphocyte counts, ferritin and D-dimer values.
The average cost of tocilizumab therapy is $500-1000, while it is $30 in pulsed methylprednisolone treatment. The present study found that treatment with pulsed methylprednisolonewhich is cheap and easy to access can be a good alternative to tocilizumab therapy in mild ARDS related to COVID-19 pneumonia.

Anahtar Kelimeler

COVID-19, Tocilizumab, methylprednisolone

Kaynakça

• 1. World Health Organization. Novel coronavirus – China. Available at: www.who.int/csr/don/12-january-2020-novel-coronaviruschina/en/. Accessed 09 Jul 2020.
• 2. Chaomin Wu, Xiaoyan Chen, Yanping Cai, Jia'an Xia, Xing Zhou, Sha Xu, Hanping Huang, Li Zhang, Xia Zhou, Chunling Du, Yuye Zhang, Juan Song, Sijiao Wang, Yencheng Chao, Zeyong Yang, Jie Xu, Xin Zhou, Dechang Chen, Weining Xiong, Lei Xu, Feng Zhou, Jinjun Jiang, Chunxue Bai, Junhua Zheng, Yuanlin Song, Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020 Jul 1;180(7):934-943.
• 3. Santosha A Vardhana, Jedd D Wolchok,The many faces of the anti-COVID immune response.J Exp Med. 2020 Jun 1;217(6):e20200678.
• 4. Crayne CB, Albeituni S, Nichols KE, Cron RQ, The immunology of macrophage activation syndrome. Front Immunol. 2019 Feb 1;10:119.
• 5. Puja Mehta, Daniel F McAuley, Michael Brown, Emilie Sanchez, Rachel S Tattersall, Jessica J Manson, HLH Across Speciality Collaboration, UK, COVID-19:consider cytokine storm syndromes and immune suppression,Lancet. 2020 Mar 28;395(10229):1033-1034.
• 6. Wen Zhang, Yan Zhao, Fengchun Zhang, Qian Wang, Taisheng Li, Zhengyin Liu, Jinglan Wang, Yan Qin, Xuan Zhang, Xiaowei Yan, Xiaofeng Zeng, Shuyang Zhang, The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the perspectives of clinical immunologists from China. Clin Immunol. 2020 May;214:108393.
• 7. Yajing Fu, Yuanxiong Cheng, Yuntao Wu,Understanding SARS-CoV-2- mediated inflammatory responses: from mechanisms to potential therapeutic tools. Virol Sin. 2020 Jun;35(3):266-271.
• 8. Nicola Potere, Marcello Di Nisio, Donatella Cibelli, Rosa Scurti, Antonella Frattari, Ettore Porreca, Antonio Abbate, Giustino Parruti, Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyper-inflammation: a case-control study.Ann Rheum Dis. 2021 Feb;80(2):1-2.
• 9. Xiaoling Xu, Mingfeng Han, Tiantian Li, Wei Sun, Dongsheng Wang, Binqing Fu, Yonggang Zhou, Xiaohu Zheng, Yun Yang, Xiuyong Li, Xiaohua Zhang, Aijun Pan, Haiming Wei. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020 May 19;117(20):10970-10975.
• 10. JP Zhao, Y Hu, RH Du, ZS Chen, Y Jin, M Zhou, J Zhang, JM Qu, B Cao. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):183-184.
• 11. Ramin Hamidi Farahani, Reza Mosaed, Amir Nezami-Asl, Mohsen chamanara, Saeed Soleiman-Meigooni, Shahab Kalantar, Mojtaba Yousefi zoshk, Ebad Shiri Malekabad, Ebrahim Hazrati. Evaluation of the Effectiveness of Methylprednisolone Pulse Treatment in the Treatment of Covid-19 Adult Patients with Severe Respiratory Failure: A Randomized, Clinical Trial.
• 12. Jishnu Malgie, Jan W Schoones, Bart G Pijls. Decreased mortality in COVID-19 patients treated with Tocilizumab: a rapid systematic review and meta-analysis of observational studies. Clin Infect Dis. 2020 Sep 23;ciaa1445.
• 13. J Eimer, J Vesterbacka, A-K Svensson, B Stojanovic, C Wagrell, A Sönnerborg, P Nowak. Tocilizumab shortens time on mechanical ventilation and length of hospital stay in patients with severe COVID‐19: a retrospective cohort study J Intern Med. 2021 Mar;289(3):434-436.
• 14. Guillermo Ruiz-Irastorza, Jose-Ignacio Pijoan, Elena Bereciartua, Susanna Dunder, Jokin Dominguez, Paula Garcia-Escudero, Alejandro Rodrigo, Carlota Gomez-Carballo, Jimena Varona, Laura Guio, Marta Ibarrola, Amaia Ugarte, Agustin Martinez-Berriotxoa. On behalf of the Cruces COVID Study Group Second week methyl-prednisolone pulsesimprove prognosis in patients with severecoronavirus disease 2019 pneumonia: Anobservational comparative study using routine care data.PLoS One. 2020 Sep 22;15(9):e0239401.
• 15. Chaomin Wu, Xiaoyan Chen, Yanping Cai, Jia'an Xia, Xing Zhou, Sha Xu, Hanping Huang, Li Zhang, Xia Zhou, Chunling Du, Yuye Zhang, Juan Song, Sijiao Wang, Yencheng Chao, Zeyong Yang, Jie Xu, Xin Zhou, Dechang Chen, Weining Xiong, Lei Xu, Feng Zhou, Jinjun Jiang, Chunxue Bai, Junhua Zheng, Yuanlin Song. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, ChinaJAMA Intern Med. 2020 Jul 1;180(7):934-943.
• 16. V Yu Mareev, Ya A Orlova, E P Pavlikova, S T Matskeplishvili, T N Krasnova, P S Malahov, L M Samokhodskaya, E A Mershina, V E Sinitsyn, Yu V Mareev, A L Kalinkin, Yu L Begrambekova, A A Kamalov. Steroid pulse -therapy in patients With coronAvirus Pneumonia (COVID-19), sYstemic inFlammation And Risk of vEnous thRombosis and thromboembolism (WAYFARER Study). Kardiologiia. 2020 Jul 7;60(6):15-29.
• 17. Stone JH, Frigault MJ, Serling-Boyd NJ, et all. Efficacy of Tocilizumab in Patients Hospitalized with Covid-19. N Engl J Med. 2020 Dec 10;383(24):2333-2344. doi: 10.1056/NEJMoa2028836. Epub 2020 Oct 21. PMID: 33085857; PMCID: PMC7646626.
• 18. Olivier Hermine, Xavier Mariette, Pierre-Louis Tharaux, Matthieu Resche-Rigon, Raphaël Porcher, Philippe Ravaud, CORIMUNO-19 Collaborative Group. Effect of tocilizumab vs usual care in adults hospitalized with COVID-19 and moderate or severe pneumonia: A randomized clinical trial. JAMA Intern Med. 2021 Jan 1;181(1):32-40.
• 19. Zhenwei Yang, Jialong Liu, Yunjiao Zhou, Xixian Zhao, Qiu Zhao, Jing Liu, The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis,J Infect. 2020 Jul;81(1):e13-e20.