other مقایسه اثر بخشی باریسیتینیب، توسیلیزومب و کورتیکواستروئید- با دوز بالا در بیماران مبتلا به کووید-19: یک مطالعه گذشته‌نگر عفونی infectious پژوهشي Original <span style="font-size:12pt"><span style="line-height:110%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#1f4e79"><span style="letter-spacing:-.2pt">زمینه:</span></span></span></span></span></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.2pt">داروهای تعدیل‌کننده سیستم ایمنی می‌توانند اثرات جانبی را در بیماران ایجاد کند، با توجه به اینکه سودمندی و تأثیر داروهای تعدیل‌کننده سیستم ایمنی به‌طور کافی در بیماران با کووید-19 مشخص نشد؛ در این تحقیق مقایسه تأثیر داروهای تعدیل‌کننده سیستم ایمنی در درمان کووید-19 مورد بررسی قرار گرفته است.</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:110%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#1f4e79">مواد و روش‌ها:</span></span></span></span></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">این مطالعه‌ی گذشته‌نگر- توصیفی- تحلیلی روی </span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">165</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"> بیمار مبتلا به کووید-19 در سال </span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">1400</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"> انجام شد. متغیرهای دموگرافیک و پاراکلینیک بیماران تحت درمان با باریسیتینیب، توسیلیزومب و کورتیکواستروئید- دوز بالا مورد مقایسه قرار گرفتند. داده‌ها وارد نرم‌افزار </span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">SPSS</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"> ویرایش </span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">26</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">، و با شاخص‌های توصیفی، آزمون تعقیبی، کای-دو و آنالیز واریانس تجزیه و تحلیل شدند (0</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">/05></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">p</span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d">). </span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:110%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#1f4e79">یافته‌ها:</span></span></span></span></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">از</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> 165</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> بیمار مورد مطالعه، 61/</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">8</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد با بهبودی نسبی ترخیص شدند. میزان اکسیژن اولیه (0/001=</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">p</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">)، لاکتات دهیدروژناز (0/010=</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">p</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">) و تعداد روزهای بستری (0/029=</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">p</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">) در گروه‌های درمانی، تفاوت معنی‌داری داشت. درصد فراوانی بیماران با لوله‌گذاری در نای، در گروه توسیلیزومب (</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">25</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">/</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">2</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد) و کورتیکواستروئید- دوز بالا (</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">25</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">/</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">5</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد)، نسبت به گروه باریسیتینیب (</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">5/5</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد) بیشتر بود (0/008=</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">p</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">). بیماران فوت شده در گروه کورتیکواستروئید- دوز بالا (</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">40</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد) بیشتر از دو گروه توسیلیزومب (20 درصد) و باریسیتینیب (</span></span></span></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">16/4</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"> درصد) بودند (0/007=</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">p</span></span></span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">). </span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:110%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#1f4e79"><span style="letter-spacing:-.1pt">نتیجه‌گیری:</span></span></span></span></span></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt">میزان اکسیژن اولیه، در گروه توسیلیزومب، کمتر از دو گروه باریسیتینیب و کورتیکواستروئید-دوز بالا بود و بیشتر بیماران با وضعیت بحرانی بودند. میزان اکسیژن اولیه، لاکتات دهیدروژناز، میانگین تعداد روزهای بستری و تعداد بیماران با وضعیت بحرانی، در هرسه گروه دارویی تفاوت معنی‌داری داشت.</span></span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:110%"><span iransans="" style="font-family:"><span style="color:#0d0d0d"><span style="letter-spacing:-.1pt"></span></span></span></span></span></span></span></span></span></span><br> &nbsp; <span style="font-size:12pt"><span style="line-height:85%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060">Background:</span></span></span></span></b> <span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#404040"><span style="letter-spacing:.1pt">Immunomodulatory medications can induce adverse effects in patients. Because the comparative efficacy and safety of immunomodulatory medications in patients with Coronavirus Disease-2019 (COVID-19) remains insufficiently characterized, this study aimed to evaluate and compare the clinical effects of different immunomodulatory medications in COVID-19 treatment.</span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:85%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060">Materials and Methods</span></span></span></span></b><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#404040"><span style="letter-spacing:.1pt">:</span></span></span></span></span></b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#404040"><span style="letter-spacing:.1pt"> This retrospective, descriptive-analytical study evaluated 165 patients diagnosed with COVID-19 in 2022. Demographic and paraclinical variables were compared among patients treated with baricitinib, tocilizumab, and high-dose corticosteroids. Data were analyzed in SPSS version 26, employing descriptive indices, post hoc test, chi-square, and analysis of variance. A p-value of < 0.05 was considered statistically significant.</span></span></span></span></span><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060"></span></span></span></span></b></span></span></span><br> <span style="font-size:12pt"><span style="line-height:85%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060">Results:</span></span></span></span></b> <span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#404040"><span style="letter-spacing:.1pt">Of the 165 patients studied, 61.8% were discharged with partial recovery. Significant differences were observed across the treatment groups regarding initial oxygen levels (p = 0.001), lactate dehydrogenase (p = 0.010), and the length of hospital stay (p = 0.029). The requirement for tracheal intubation was significantly higher in the tocilizumab (25.5%) and high-dose corticosteroid (25.5%) groups than that in the baricitinib group (5.5%) (p = 0.008). Furthermore, the mortality rate was significantly higher in patients receiving high-dose corticosteroids (40%) than in the tocilizumab (20%) and baricitinib (16.4%) groups (p = 0.007).</span></span></span></span></span><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060"></span></span></span></span></b></span></span></span><br> <span style="font-size:12pt"><span style="line-height:85%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#002060">Conclusion:</span></span></span></span></b> <span style="font-size:9.0pt"><span style="line-height:85%"><span iransans="" style="font-family:"><span style="color:#404040"><span style="letter-spacing:.1pt">Patients in the tocilizumab group presented with lower initial oxygen levels compared with the baricitinib and high-dose corticosteroid groups, and a majority of them were in critical condition. Overall, significant differences were found among the three interventions concerning initial oxygen level, lactate dehydrogenase, the mean length of hospital stay, and the incidence of critical clinical outcomes.</span></span></span></span></span></span></span></span><br> &nbsp; باریسیتینیب, توسیلیزومب, کورتیکواسترویید, کووید-19 Baricitinib, Tocilizumab, Corticosteroids, Covid-19 234 246 http://ismj.bpums.ac.ir/browse.php?a_code=A-10-1115-102&slc_lang=other&sid=1 Parviz Amri Maleh پرویز امری مله 5700319475328460021211 5700319475328460021211 No Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran واحد توسعه تحقیقات بالینی بیمارستان ایت اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران Elmira Atania المیرا عطانیا 5700319475328460021212 5700319475328460021212 No Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran واحد توسعه تحقیقات بالینی بیمارستان ایت اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران Hemmat Gholinia Ahangar همت‌اله قلی‌نیا آهنگر 5700319475328460021213 5700319475328460021213 No Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran واحد توسعه تحقیقات بالینی بیمارستان ایت اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران Mana Baziboroun مانا بازی‌برون m.bazibotoun@sbmu.ac 5700319475328460021214 5700319475328460021214 Yes Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran واحد توسعه تحقیقات بالینی بیمارستان ایت اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران