Volume 26, Issue 5 (Iranian South Medical Journal 2024)
Iran South Med J 2024, 26(5): 273-283 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rastegar R, Heidary M, Motamed N, Abbasi F. Comparing the Effect of Tocilizumab and Methylprednisolone Pulse on Mortality and Outcomes in Patients with Severe COVID-19 in Bushehr. Iran South Med J 2024; 26 (5) :273-283
URL: http://ismj.bpums.ac.ir/article-1-1867-en.html
URL: http://ismj.bpums.ac.ir/article-1-1867-en.html
1- Department of Infectious Diseases, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran , r_rastegar64@yahoo.com
2- Student Research Committee, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
3- Department of Community Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
4- Department of Infectious Diseases, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
2- Student Research Committee, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
3- Department of Community Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
4- Department of Infectious Diseases, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
Abstract: (843 Views)
Background: The effect of Tocilizumab and high dose of corticosteroid on COVID-19 mortality and out-comes is equivocal. This study was designed to compare the effect of tocilizumab and Methylpredniso-lone pulse dose on mortality, outcomes and duration of hospitalization in severe COVID-19 patients.
Materials and Methods: The above research was a retrospective study conducted on 131 patients with severe COVID-19 admitted to the acute respiratory ward of Shohadaye Khalije Fars Hospital in Bushehr, Iran, from March to October 2021. Of these patients, 66 were assigned to the methylprednisolone pulse group and 65 to the tocilizumab group and the two groups were then compared in terms of clinical out-comes, laboratory test results, and lung imaging findings.
Results: The results of the study showed that the percentage of mortality, the mean duration of hospitali-zation, and the rate of requirement for intubation were not signiciantly different between the methylpred-nisolone pulse and the tocilizumab groups (P>0.05). The improvement in CRP and arterial oxygen satura-tion was significantly different between the two groups after treatment (P<0.01).
Conclusion: High dose of methylprednisolone in severely ill patients was associated with faster recovery of the patients in terms of arterial oxygenation and the inflammatory marker CRP. Nevertheless, there was no difference between the two drugs in terms of mortality rate and prognosis. Therefore methylprednisolone pulse dose can be a good alternative to tocilizumab in severe COVID-19.
Materials and Methods: The above research was a retrospective study conducted on 131 patients with severe COVID-19 admitted to the acute respiratory ward of Shohadaye Khalije Fars Hospital in Bushehr, Iran, from March to October 2021. Of these patients, 66 were assigned to the methylprednisolone pulse group and 65 to the tocilizumab group and the two groups were then compared in terms of clinical out-comes, laboratory test results, and lung imaging findings.
Results: The results of the study showed that the percentage of mortality, the mean duration of hospitali-zation, and the rate of requirement for intubation were not signiciantly different between the methylpred-nisolone pulse and the tocilizumab groups (P>0.05). The improvement in CRP and arterial oxygen satura-tion was significantly different between the two groups after treatment (P<0.01).
Conclusion: High dose of methylprednisolone in severely ill patients was associated with faster recovery of the patients in terms of arterial oxygenation and the inflammatory marker CRP. Nevertheless, there was no difference between the two drugs in terms of mortality rate and prognosis. Therefore methylprednisolone pulse dose can be a good alternative to tocilizumab in severe COVID-19.
Type of Study: Original |
Subject:
infectious
Received: 2023/12/6 | Accepted: 2024/02/20 | Published: 2024/05/5
Received: 2023/12/6 | Accepted: 2024/02/20 | Published: 2024/05/5
References
1. Campochiaro C, Della-Torre E, Cavalli G, et al. Efficacy and safety of tocilizumab in severe COVID-19 patients: a single centre retrospective cohort study. Eur J Intern Med 2020; 76: 43-49. [DOI]
2. COVID-Coronavirus Statistics. Worldometer. (Accessed January 27, 2024, at https://www.worldometers.info/coronavirus) [Article]
3. Aslan M, Sabaz MS, Yilmaz R, et al. Effect of pulsed corticosteroids and tocilizumab on hyperinflammation in COVID-19 patients with acute respiratory distress syndrome. J Acute Dis 2021; 10(5): 195-201. [DOI]
4. Elrobaa IH, New KJ. COVID-19: Pulmonary and Extra pulmonary Manifestations. Front Public Health 2021; 9: 711616. [DOI]
5. Tavakoli A, Vahdat K, Keshavarz M. Novel Coronavirus Disease 2019 (COVID -19): An Emerging Infectious Disease in the 21st Century. Iran South Med J 2020; 22(6): 432-450. [DOI]
6. Esendagli D, Yilmaz A, Akcay Ş, et al. Postcovid syndrome: Pulmonary complications. Turk J Med Sci 2021; 51(SI-1): 3359-3371. [DOI]
7. Lim PC, Wong KL, Rajah R, et al. Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis. Daru 2022; 30(1): 211-228. [DOI]
8. Abbasian L, Toroghi N, Rahmani H, et al. Comparing efficacy and safety of tocilizumab and methylprednisolone in the treatment of patients with severe COVID-19. Int Immunopharmacol 2022; 107: 108689. [DOI]
9. Diagnosis and Treatment Guideline of COVID19 for hospitalized and outpatient management. 2023: 1-115. [Article]
10. Çil B, Kabak M. Comparative Evaluation of Tocilizumab Versus High Dose Methylprednisolone Therapy in Mild Acute Respiratory Distress Syndrome Related to Covid-19 Pneumonia: A Retrospective Cohort Study. New Trend Med Sci 2021; 2(2): 130-135. [Article]
11. Kumar V, Kashyap AK, Kaur S, et al. Comparison of Tocilizumab and High-dose Methylprednisolone Pulse on Outcomes in Severe Corona Virus Disease-2019: TAME-COVID, a Retrospective Multicentric Study. Int J Appl Basic Med Res 2021; 11(4): 263-269. [DOI]
12. Aziz M, Fatima R, Assaly R. Elevated interleukin‐6 and severe COVID‐ 19: a meta‐analysis. J Med Virol 2020; 92(11): 2283-2285. [DOI]
13. Gordon AC, Mouncey PR, Al-Beidh F, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med 2021; 384(16): 1491-1502. [DOI]
14. Salama C, Han J, Yau L, et al. Tocilizumab in patients hospitalized with Covid-19 pneumonia. N Engl J Med 2021; 384(1): 20-30. [DOI]
15. Callejas Rubio JL, Luna Del Castillo JD, de la Hera Fernández J, et al. Effectiveness of corticoid pulses in patients with cytokine storm syndrome induced by SARS-CoV-2 infection. Med Clin (Engl Ed) 2020; 155(4): 159-61. [DOI]
16. Rodríguez-Baño J, Pachón J, Carratalà J, et al. Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAMCOVID-19). Clin Microbiol Infect 2021; 27(2): 244-52. [DOI]
17. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. Eur Respir J 2020; 56(6): 2002808. [DOI]
18. Rosas IO, Bräu N, Waters M, et al. Tocilizumab in hospitalized patients with COVID-19 pneumonia. MedRxiv 2020. [DOI]
19. Jeronimo CMP, Farias MEL, Val FFA, et al. Methylprednisolone as adjunctive therapy for patients hospitalized with coronavirus disease 2019 (COVID-19; Metcovid): a randomized, double-blind, phase IIb, placebo-controlled trial. Clin Infect Dis 2021; 72(9): e373-e81. [DOI]
20. Sahi QN, Ahmad M, Kiran M, et al. Outcome Comparison Between Tocilizumab and Pulse Solumedrol in Severe Covid Disease Among Resource Depleted Areas. Pakistan J Med Health Sci 2022; 16(10): 559-561. [DOI]
21. Gamberini L, Tonetti T, Spadaro S, et al. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs. J Intensive Care 2020; 8: 80. [DOI]
22. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506. [DOI]
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
