Use of tocilizumab in the combination treatment of a COVID-19 patient with concomitant rheumatoid arthritis (a case report)

Візір, Вадим Анатолійович; Sadomov, A. S.; Demidenko, O. V.

doi:10.14739/2310-1210.2021.5.232322

Cited by 2 publications

(3 citation statements)

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“…In our opinion, this is especially true for certain categories of patients with COVID-19 who have risk factors in the form of comorbid conditions, in the pathogenetic mechanisms of which immunological changes are leading [17,18]. There is already a clear pathogenetic justification and successful experience in the literature on the use of tocilizumab in the treatment of patients with severe COVID-19 on the background of comorbid rheumatoid arthritis [18]. Tocilizumab in the treatment of pregnant women with severe and critical course of COVID-19, according to researchers [19], deserves special attention.…”

Section: висновкиmentioning

confidence: 99%

“…Therefore, clinical and laboratory eva luation of the immunotropic treatment effectiveness with tocilizumab remains relevant today [16]. In our opinion, this is especially true for certain categories of patients with COVID-19 who have risk factors in the form of comorbid conditions, in the pathogenetic mechanisms of which immunological changes are leading [17,18]. There is already a clear pathogenetic justification and successful experience in the literature on the use of tocilizumab in the treatment of patients with severe COVID-19 on the background of comorbid rheumatoid arthritis [18].…”

Section: висновкиmentioning

confidence: 99%

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Clinical experience with tocilizumab in the treatment of pregnant woman with severe COVID-19

et al. 2022

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The aim of the work – to present a case of positive use of tocilizumab in the treatment of pregnant woman with severe COVID-19. Materials and methods. A self-observation clinical case of severe coronavirus disease (COVID-19) in pregnant K., 40 years old, who was treated at Municipal Non-Profit Enterprise “Regional Infectious Diseases Clinical Hospital” of Zaporizhzhia Regional Council. The patient was treated in accordance with the “Protocol for the provision of medical care for the treatment of coronavirus disease (COVID-19)”. Results. Our own clinical observation demonstrates the formation of severe COVID-19 in a 40-year-old pregnant woman in the second trimester of pregnancy. Combination treatment with glucocorticoids in the presence of oxygen dependence on the 11th day of the disease was ineffective for two days of clinical and laboratory parameters monitoring, which required a decision on the additional appointment of tocilizumab. The development of “cytokine storm” clinical and laboratory signs on the 12th day of the disease was evidenced by the preservation of fever in the range of 37.5–37.8 °C, no regression of oxygen dependence. According to laboratory data, an increase in the severity of lymphopenia as a relative quantity – up to 5 % and absolute quantity – up to 0.5 × 109/l, an increase in fibrinogen – up to 5.8 g/l and D-dimer – up to 1.9 ng/ml, high level of C-reactive protein – up to 190 mg/l. These data justify the additional use of tocilizumab, which was administered at a dose of 8 mg/kg in the absence of contraindications. Tocilizumab administration was effective, contributing to oxygen dependence regression and recovery of laboratory parameters within a week. Conclusions. Our own clinical observation demonstrates the formation of severe COVID-19 in pregnant woman in the second trimester of pregnancy. Due to the ineffectiveness of glucocorticosteroid therapy and the presence of clear clinical and laboratory signs of “cytokine storm” on the 12th day of the disease, the use of tocilizumab was effective, which contributed to the oxygen dependence regression and recovery of laboratory parameters within a week. Treatment of pregnant woman with severe COVID-19 requires adherence to existing protocols.

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Section: висновкиmentioning

confidence: 99%

Section: висновкиmentioning

confidence: 99%

Clinical experience with tocilizumab in the treatment of pregnant woman with severe COVID-19

et al. 2022

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“…In accordance with existing international recommendations, tocilizumab was also included in the Protocol for the provision of medical assistance for the treatment of coronavirus disease (COVID-19) and approved by the Order of the Ministry of Health of Ukraine as an additional therapy to corticosteroids in severe and critical course of the disease, in which rapid decompensation of breathing is noted. This made it possible to use this variant of immunotropic treatment in patients who belong to the risk group due to the presence of comorbid conditions [21,22]. However, the results of various studies regarding the effectiveness of the use of tocilizumab in clinical practice have certain discrepancies.…”

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The role of clinical and immunological parameters in predicting the effectiveness of additional immunotropic therapy in oxygen-dependent patients with COVID-19 coronavirus disease

Riabokon,

Cherkaskyi,

Riabokon

et al. 2023

Pathologia

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Aim. The purpose of the research is to find out the role of clinical and immunological parameters in predicting the effectiveness of additional immunotropic therapy in oxygen-dependent patients with the coronavirus disease COVID-19. Material and methods. 79 oxygen-dependent patients with COVID-19 were examined, who received additional therapy with tocilizumab according to current protocols. The patients were divided into groups: I group – 39 patients who recovered; group II – 40 patients with a fatal outcome of the disease. The content of ferritin (Monobind Inc., USA), interleukin (IL) IL-2 (Elabscience, USA), IL-6 (Invitrogen, Austria), monocyte chemotactic protein-1 (MCP-1) (Elabscience, USA) was determined in the blood serum of patients and persons of the control group by the method of immunoenzymatic analysis. Statistical processing of the obtained data was carried out in the program Statistica 13 for Windows (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Threshold levels of immunological parameters at different stages of observation, which have prognostic value regarding the risk of a fatal outcome of COVID-19, have been established. After 5 days of tocilizumab administration, the preservation of the indicator of the absolute number of blood lymphocytes ≤1.2 × 109/l (AUC = 0.631, p = 0.039), CRP level >67.5 mg/l (AUC = 0.670, p = 0.020), IL-2 >309.45 pg/ml (AUC = 0.761, p = 0.013), IL-6 >4.66 pg/ml (AUC = 0.871, p < 0.001) indicated a high probability of developing a fatal outcome of the disease in patients with COVID-19. The analysis of the diagnostic significance of ferritin showed the informativeness of the level of its increase as at the time of the start of observation >548.02 ng/ml (AUC = 0.718, p = 0.004) and after 5 days the application of additional immunotropic therapy >443.55 ng/ml (AUC = 0.736, p = 0.026). It has been proven that, in addition to immunological parameters, when assessing the probability of a fatal outcome of COVID-19, such clinical parameters as the presence of febrile fever at the time of the appearance of oxygen dependence (p < 0.05) and the duration of oxygen dependence at the time of additional immunotropic therapy with tocilizumab are informative (p < 0.05). Under the conditions of additional immunotropic therapy with tocilizumab more than 4 days after the onset of oxygen dependence, the probability of ineffectiveness of the specified additional treatment was significant (AUC = 0.756, p < 0.001). Conclusions. The dynamics of immunological parameters in oxygen-dependent patients with COVID-19 during additional immunotropic therapy with tocilizumab has certain features with different treatment results. When predicting the probable risk of a fatal outcome of the disease, clinical parameters are informative, namely the appearance of febrile fever during the development of oxygen dependence and the duration of oxygen dependence until the moment of tocilizumab administration, and immunological parameters, namely the level of the absolute content of lymphocytes, ferritin, CRP, IL-2, IL-6 in the blood.

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Use of tocilizumab in the combination treatment of a COVID-19 patient with concomitant rheumatoid arthritis (a case report)

Cited by 2 publications

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Clinical experience with tocilizumab in the treatment of pregnant woman with severe COVID-19

Clinical experience with tocilizumab in the treatment of pregnant woman with severe COVID-19

The role of clinical and immunological parameters in predicting the effectiveness of additional immunotropic therapy in oxygen-dependent patients with COVID-19 coronavirus disease

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