Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients

Abstract

Background Critical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ. Methods From September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy. Results Among non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p < 0.05), than the standard therapy group. All HD patients in the standard therapy group with oxygen demand exceeding 8 L/min died. Contrastingly, all patients in the TCZ + mPSL pulse group survived, with their oxygen demand decreasing to 0–1 L/min within 3 weeks post-administration. Conclusion TCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation.

Usage of Biological Therapy in Rheumatoid Arthritis Patients with Chronic Renal Failure: A Retrospective Study from a Single Center

“…TNFi'lerinin çeşitli vaka serilerinde hemodiyaliz veya periton diyalizi gibi renal replasman tedavisi gören RA hastalarında da güvenli ve etkili olduğu gösterilmiştir 10,12,22,23 . Benzer şekilde tosilizumabın hemodiyalize giren RA hastalarında güvenli olduğunu bildiren daha eski vaka bildirileri 21,24 bulunmaktadır, yanı sıra COVID-19 döneminde hemodiyaliz hastalarında güvenle kullanıldığına dair yeni vaka bildirileri de yapılmıştır 25,26,27 . Serum AA (SAA) üretiminin baskılanması AA amiloidozunun kontrolü için gereklidir 28 .…”

El papel de los corticoesteroides en pacientes hospitalizados por COVID-19 en el Hospital General de México

“…Distintas publicaciones en todo el mundo documentaron la evidencia científica de los beneficios de los GC en este tipo de pacientes [15][16][17] ; sin embargo, también existen estudios en los que se ha observado un efecto negativo, sobre todo en pacientes con comorbilidad [18][19][20] . En el estudio de Provencio et al 21 se hace referencia a que el riesgo de muerte fue significativamente mayor en los pacientes que recibieron GC durante la hospitalización, en comparación con aquellos que no los recibieron (51.3% vs. 25.7%; p < 0.001).…”

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

“…However, the RECOVERY trial, which included SpO 2 < 92% or oxygen administration in addition to C-reactive protein > 7.5 mg/dL, [ 21 ] and the REMAP-CAP trial in severe patients showed a significant reduction in mortality in the tocilizumab group [ 21 ]. Furthermore, Toda et al reported the efficacy of combining tocilizumab and steroid pulse therapy in dialysis patients [ 22 ]. Further studies are required to determine the appropriate target patients and the timing of administration, and evaluate the possibility of the combination therapy, particularly in critically ill patients.…”