The safety and effectiveness of tocilizumab in older adult critically ill patients with COVID-19: a multicenter, cohort study

Korayem, Ghazwa B.; Aljuhani, Ohoud; Altebainawi, Ali F.; Shaya, Abdulrahman I Al; Alnajjar, Lina I.; Alissa, Abdulrahman; Aldhaeefi, Mohammed; Kensara, Raed; Muqati, Hessa Al; Alhuwahmel, Abdulmohsen; Alhuthaili, Omar; Vishwakarma, Ramesh; Aldardeer, Namareq; Eljaaly, Khalid; Alharbi, Aisha; Harbi, Shmeylan Al; Katheri, Abdulmalik Al; Bekairy, Abdulkareem M. Al; Al‐Jedai, Ahmed; Sulaiman, Khalid Al

doi:10.1016/j.ijid.2022.05.038

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Studies have also reported a significant decrease in serum antibody titers after the vaccination of patients aged ≥65 years ( 27 , 28 ). Older patients' immune systems are usually weaker, and their B and T cells are less responsive to external stimuli ( 29 ). In addition, we found no significant difference in immunogenicity between participants receiving inactivated or recombinant protein vaccines in the cancer or healthy control group.…”

Section: Discussionmentioning

confidence: 99%

Safety and immunogenicity of the third (booster) dose of inactivated and recombinant protein SARS-CoV-2 vaccine for patients with endocrine-related cancer

Han

Yang²,

Wang³

et al. 2023

Front. Public Health

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BackgroundOur study aimed to evaluate the safety and immunogenicity of the third (booster) dose of the COVID-19 vaccine for patients with endocrine-related cancers.MethodsThis observational study involved 94 breast cancer patients, 92 thyroid cancer patients, and 123 healthy individuals who had received the third (booster) dose of the COVID-19 vaccine. Data on the adverse effects, serum anti-receptor binding domain (RBD)-immunoglobulin (Ig) G, and neutralizing antibodies (NAbs) were collected prospectively.ResultsThe serum anti-RBD-IgG and NAb titers were significantly lower for the patients with endocrine-related malignancies than for the healthy controls (3.01 [IQR: 1.11–6.70] vs. 4.19 [1.95–9.11], p = 0.001; 0.23 [0.11–0.52] vs. 0.41 [0.22–0.78], p = 0.001), and the seroconversion rates of anti-RBD-IgG and NAbs showed similar results. The serum antibody titers and seroconversion rates were significantly lower for patients aged ≥65 years with endocrine-related cancers, but there were no significant differences related to gender, vaccine type, or cancer type. Subgroup analysis showed that the antibody titers and seroconversion rates were significantly lower for patients with intermediate to advanced breast cancer, HR–/Her2+ breast cancer, and breast cancer undergoing treatment than for healthy controls. In contrast, breast cancer patients who completed their treatment and those who received endocrine therapy after completing their treatment were not significantly different from healthy controls. The NAbs titers and seroconversion rates were significantly lower for patients with primary thyroid cancer (0.19 [IQR: 0.10–0.46] vs. 0.41 [0.22–0.78], p = 0.003; 55.9 vs. 84.9%, p < 0.001); the seroconversion rates were significantly higher for the patients with combined Hashimoto's thyroiditis than for those without it. Multiple linear regression showed that patients aged ≥65 years who were receiving treatment were at risk of having lower antibody levels.ConclusionThe third (booster) dose of the COVID-19 vaccine is safe and well-tolerated. Our data support a third (booster) dose of the SARS-CoV-2 vaccine for breast and thyroid cancer patients. Breast cancer patients aged ≥65 years who are receiving treatment should be more protected, while thyroid cancer and breast cancer patients who have completed their treatment can be vaccinated like the general population.

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Section: Discussionmentioning

confidence: 99%

Safety and immunogenicity of the third (booster) dose of inactivated and recombinant protein SARS-CoV-2 vaccine for patients with endocrine-related cancer

Han

Yang²,

Wang³

et al. 2023

Front. Public Health

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“…25 Our current study design and methods were based on our previous studies. Details of previous studies' designs and methodology have been published previously [26][27][28][29][30] . This is a multicenter retrospective cohort study of adult patients with COVID-19 admitted to the intensive care units (ICUs) at five centers in Saudi Arabia between March 1, 2020, and July 31, 2021.…”

Section: Methodsmentioning

confidence: 99%

Doxycycline’s Potential Role in Reducing Thrombosis and Mortality in Critically Ill Patients With COVID-19: A Multicenter Cohort Study

Al Sulaiman,

Aljuhani,

Korayem

et al. 2023

Clin Appl Thromb Hemost

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Doxycycline has revealed potential effects in animal studies to prevent thrombosis and reduce mortality. However, less is known about its antithrombotic role in patients with COVID-19. Our study aimed to evaluate doxycycline's impact on clinical outcomes in critically ill patients with COVID-19. A multicenter retrospective cohort study was conducted between March 1, 2020, and July 31, 2021. Patients who received doxycycline in intensive care units (ICUs) were compared to patients who did not (control). The primary outcome was the composite thrombotic events. The secondary outcomes were 30-day and in-hospital mortality, length of stay, ventilator-free days, and complications during ICU stay. Propensity score (PS) matching was used based on the selected criteria. Logistic, negative binomial, and Cox proportional hazards regression analyses were used as appropriate. After PS (1:3) matching, 664 patients (doxycycline n = 166, control n = 498) were included. The number of thromboembolic events was lower in the doxycycline group (OR: 0.54; 95% CI: 0.26-1.08; P = .08); however, it failed to reach to a statistical significance. Moreover, D-dimer levels and 30-day mortality were lower in the doxycycline group (beta coefficient [95% CI]: −0.22 [−0.46, 0.03; P = .08]; HR: 0.73; 95% CI: 0.52-1.00; P = .05, respectively). In addition, patients who received doxycycline had significantly lower odds of bacterial/fungal pneumonia (OR: 0.65; 95% CI: 0.44-0.94; P = .02). The use of doxycycline as adjunctive therapy in critically ill patients with COVID-19 might may be a desirable therapeutic option for thrombosis reduction and survival benefits.

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“…On the other hand, the concurrent use of oral baricitinib [ 44 , 45 ] or intravenous tocilizumab [ 46 ] should be explored in rapidly deteriorating patients. For those requiring interventions such as high-flow nasal cannula, non-invasive ventilation, MV, or extracorporeal membrane oxygenation (ECMO), the addition of oral baricitinib [ 44 , 47 ] or intravenous tocilizumab [ 46 , 48 ] to dexamethasone [ 40 , 43 ] is feasible. When administered to older patients, both tocilizumab [ 48 ] and baricitinib [ 47 ] have been observed to reduce the risk of mortality.…”

Section: Treatment and Preventionmentioning

confidence: 99%

“…For those requiring interventions such as high-flow nasal cannula, non-invasive ventilation, MV, or extracorporeal membrane oxygenation (ECMO), the addition of oral baricitinib [ 44 , 47 ] or intravenous tocilizumab [ 46 , 48 ] to dexamethasone [ 40 , 43 ] is feasible. When administered to older patients, both tocilizumab [ 48 ] and baricitinib [ 47 ] have been observed to reduce the risk of mortality. In a study [ 40 ] on inpatients with COVID-19 with a median age of 64 years, the use of dexamethasone reduced all-cause mortality and discharge to hospice care, particularly among patients requiring oxygen support, MV, or ECMO.…”

Section: Treatment and Preventionmentioning

confidence: 99%

Clinical Manifestations and Outcomes of Older Patients with COVID-19: A Comprehensive Review

Lee,

Kang,

Kim

et al. 2024

Tuberc Respir Dis

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The consequences of coronavirus disease 2019 (COVID-19) are particularly severe in older adults with a disproportionate number of severe and fatal outcomes. Therefore, this integrative review aimed to provide a comprehensive overview of the clinical characteristics, management approaches, and prognosis of older patients diagnosed with COVID-19. Common clinical presentations in older patients include fever, cough, and dyspnea. Additionally, preexisting comorbidities, especially diabetes and pulmonary and cardiovascular diseases, were frequently observed and associated with adverse outcomes. Management strategies varied, however, early diagnosis, vigilant monitoring, and multidisciplinary care were identified as key factors for enhancing patient outcomes. Nonetheless, the prognosis remains guarded for older patients, with increased rates of hospitalization, mechanical ventilation, and mortality. However, timely therapeutic interventions, especially antiviral and supportive treatments, have demonstrated some efficacy in mitigating the severe consequences in this age group. In conclusion, while older adults remain highly susceptible to severe outcomes from COVID-19, early intervention, rigorous monitoring, and comprehensive care can play a pivotal role in improving their clinical outcomes.

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The safety and effectiveness of tocilizumab in older adult critically ill patients with COVID-19: a multicenter, cohort study

Cited by 7 publications

References 22 publications

Safety and immunogenicity of the third (booster) dose of inactivated and recombinant protein SARS-CoV-2 vaccine for patients with endocrine-related cancer

Safety and immunogenicity of the third (booster) dose of inactivated and recombinant protein SARS-CoV-2 vaccine for patients with endocrine-related cancer

Doxycycline’s Potential Role in Reducing Thrombosis and Mortality in Critically Ill Patients With COVID-19: A Multicenter Cohort Study

Clinical Manifestations and Outcomes of Older Patients with COVID-19: A Comprehensive Review

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