Рецепт. 2022; : 7-19
Предикторы исхода при применении тоцилизумаба у пациентов с тяжелой формой COVID-19
https://doi.org/10.34883/PI.2022.25.1.004Аннотация
В ретроспективном исследовании авторы попытались найти предикторы исхода у 100 пациентов с тяжелой формой COVID-19, получивших тоцилизумаб и проходивших лечение в отделении интенсивной терапии и реанимации. Все пациенты были разделены на 2 группы в зависимости от исхода заболевания (I группа – выжившие, II группа – умершие). Среди пациентов в возрасте до 60,5 года и с индексом коморбидности Чарлсона ≤2,5 балла прогнозировалась низкая вероятность летального исхода после введения тоцилизумаба. Пациенты, у которых до инфузии тоцилизумаба определялись ИЛ-6≤101 пг/мл, альбумин в крови ≥30,5 г/л и PaO2 /FiO2 ≥125,5 мм рт. ст., относились к группе низкого риска летального исхода. Быстрое восстановление уровня лимфоцитов в крови со 2-х суток после инфузии тоцилизумаба может рассматриваться как предиктор благоприятного прогноза.
Список литературы
1. Mehta P., McAuley D.F., Brown M. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.
2. Ghosn L., Chaimani А., Evrenoglou Т. Interleukin-6 blocking agents for treating COVID-19: a living systematic review. Cochrane Database Syst Rev. 2021;3(3):CD013881. DOI: 10.1002/14651858.CD013881.
3. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10285):1637–1645. DOI: 10.1016/S0140-6736(21)00676-0.
4. Rosas I. O. Bräu N., Waters M. Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia. N. Engl J. Med. 2021;384:1503–1516. DOI: 10.1056/NEJMoa2028700.
5. Hermine O., Mariette X., Tharaux P. 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;181(1):32–40. DOI: 10.1001/jamainternmed.2020.6820.
6. Xu X., Han M., Li T. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020;117(20):10970–10975. DOI: 10.1073/pnas.2005615117.
7. Cortegiani A., Ippolito М., Greco M. Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review. Pulmonology. 2020;27(1):52–60. DOI: 10.1016/j.pulmoe.2020.07.003.
8. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis. JAMA. 2021;326(6):499–518. DOI: 10.1001/jama.2021.11330.
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11. On the issues of treating patients with COVID-19 infection. Order of the Ministry of Health of the Republic of Belarus No 690 dated 01.07.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/690.pdf (accessed 05 December 2021) (in Russian).
12. On some issues of providing medical care to patients with COVID-I9 infection. Order of the Ministry of Health of the Republic of Belarus No 1106 dated 20.10.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/1106.pdf (accessed 05 December 2021) (in Russian).
13. On amendments to the orders of the Ministry of Health of the Republic of Belarus dated June 5, 2020 № 615 and April 15, 2020 № 433. Order of the Ministry of Health of the Republic of Belarus No 1195 dated 11.11.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/1195.pdf (accessed 05 December 2021) (in Russian).
Recipe. 2022; : 7-19
Outcome Predictors of Tocilizumab Administration in Patients with Severe COVID-19
https://doi.org/10.34883/PI.2022.25.1.004Abstract
In a retrospective study, the authors attempted to find outcome predictors in 100 patients with severe COVID-19 who received Tocilizumab and were treated in the ICU. All patients were divided into 2 groups depending on the outcome of the disease (group I – survivors, group II – deceased). Among patients under the age of 60.5 years and with a Charlson comorbidity index ≤2.5 points, a low probability of death was predicted after the administration of Tocilizumab. Patients who had IL-6 ≤101 pg/ml, blood albumin ≥30.5 g/L, and PaO2 /FiO2 ≥ 25.5 mm Hg before the Tocilizumab infusion were at low risk of mortality. The rapid recovery of blood lymphocyte levels from the 2nd day after tocilizumab infusion can be considered as a predictor of the favorable prognosis.
References
1. Mehta P., McAuley D.F., Brown M. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.
2. Ghosn L., Chaimani A., Evrenoglou T. Interleukin-6 blocking agents for treating COVID-19: a living systematic review. Cochrane Database Syst Rev. 2021;3(3):CD013881. DOI: 10.1002/14651858.CD013881.
3. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10285):1637–1645. DOI: 10.1016/S0140-6736(21)00676-0.
4. Rosas I. O. Bräu N., Waters M. Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia. N. Engl J. Med. 2021;384:1503–1516. DOI: 10.1056/NEJMoa2028700.
5. Hermine O., Mariette X., Tharaux P. 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;181(1):32–40. DOI: 10.1001/jamainternmed.2020.6820.
6. Xu X., Han M., Li T. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020;117(20):10970–10975. DOI: 10.1073/pnas.2005615117.
7. Cortegiani A., Ippolito M., Greco M. Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review. Pulmonology. 2020;27(1):52–60. DOI: 10.1016/j.pulmoe.2020.07.003.
8. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis. JAMA. 2021;326(6):499–518. DOI: 10.1001/jama.2021.11330.
9. On certain issues of providing medical care to patients with COVID-19 infection. Order of the Ministry of Health of the Republic of Belarus No 488 dated 04.24.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/488.pdf (accessed 05 December 2021) (in Russian).
10. On the provision of medical care to patients with COVID-19 infection. Order of the Ministry of Health of the Republic of Belarus No 615 dated 06.05.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/615.pdf (accessed 05 December 2021) (in Russian).
11. On the issues of treating patients with COVID-19 infection. Order of the Ministry of Health of the Republic of Belarus No 690 dated 01.07.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/690.pdf (accessed 05 December 2021) (in Russian).
12. On some issues of providing medical care to patients with COVID-I9 infection. Order of the Ministry of Health of the Republic of Belarus No 1106 dated 20.10.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/1106.pdf (accessed 05 December 2021) (in Russian).
13. On amendments to the orders of the Ministry of Health of the Republic of Belarus dated June 5, 2020 № 615 and April 15, 2020 № 433. Order of the Ministry of Health of the Republic of Belarus No 1195 dated 11.11.2020. Available at: https://www.bsmu.by/downloads/universitet/lech/2020-1/covid-19/1195.pdf (accessed 05 December 2021) (in Russian).
