Criteria for the optimal use of interleukin-6 receptor blockers in patients with COVID-19
- 作者: Kruglova T.1, Fomina D.1,2, Poteshkina N.1,3, Frolova N.1, Beloglazova I.1,3, Mutovina Z.1,4, Samsonova I.1, Kovalevskaja E.1, Zagrebneva A.1,3, Serdotetckova S.1, Chernov A.1,5, Lysenko M.1,3
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隶属关系:
- City Clinical Hospital №52
- Sechenov First Moscow State Medical University (Sechenov University)
- Pirogov Russian National Research Medical University
- Central State Medical Academy of the President of the Russian Federation
- Russian Medical Academy of Continuous Professional Education
- 期: 卷 93, 编号 11 (2021)
- 页面: 1316-1324
- 栏目: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/99573
- DOI: https://doi.org/10.26442/00403660.2021.11.201248
- ID: 99573
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Aim. To determine the criteria for the optimal use of IL-6 receptor blockers in patients with COVID-19 community-acquired pneumonia based on predictors of adverse outcomes.
Materials and methods. The single-center, non-randomized prospective study included 190 patients with community-acquired pneumonia caused by coronavirus 2 between the beginning of March and the end of May 2020. Of these, 89 patients received tocilizumab and 101 patients received sarilumab. The study inclusion criterion for the patient was indications for initiating therapy with one of the inhibitors of IL-6 receptors (anti-IL-6R) according to the Interim guidelines (versions 4 and 5). The exclusion criterion was the need to re-prescribe genetically engineered biological therapy (GEBT). The severity of the patient's condition was assessed according to the early warning score (NEWS2), the volume of lung tissue lesions was assessed according to computed tomography (CT). Laboratory monitoring included counting the absolute (abs) number of lymphocytes, serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), D-dimer, lactate dehydrogenase, fibrinogen. Statistical data processing was conducted by nonparametric methods using the IBM SPSS Statistics V-22 software.
Results. The phenotype of a patient with a negative outcome prognosis was described: a male patient over 50 years of age with aggravated premorbid background (with cardiovascular diseases, obesity and/or chronic renal disease), lung lesion CT 3–4, saturation less than 93% upon inhalation of atmospheric air, persisting for 24–48 hours after GEBT. According to the blood test, lymphopenia was below 1000 U/L and CRP levels were above 50 mg/L. The laboratory parameters and clinical picture of the patient progressively worsened after 9–11 days of illness, regardless of the use of Anti-IL-6R. The features of patients monitoring when administering IL-6 receptor blockers have been determined.
Conclusion. IL-6 receptor blockers should be administered to patients hospitalized with severe COVID-19 before the development of hyperinflammatory reactions. The optimal "therapeutic window" is 7–8 days of illness.
作者简介
Tatyana Kruglova
City Clinical Hospital №52
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-4949-9178
врач аллерголог-иммунолог, зав. отд-нием аллергологии и иммунологии ГБУЗ ГКБ №52
俄罗斯联邦, MoscowDarya Fomina
City Clinical Hospital №52; Sechenov First Moscow State Medical University (Sechenov University)
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-5083-6637
канд. мед. наук, врач аллерголог- иммунолог, рук. центра аллергологии и иммунологии ГБУЗ ГКБ №52; доц. каф. клинической иммунологии и аллергологии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
俄罗斯联邦, MoscowNataliya Poteshkina
City Clinical Hospital №52; Pirogov Russian National Research Medical University
编辑信件的主要联系方式.
Email: surckova.t@yandex.ru
ORCID iD: 0000-0001-9803-2139
д-р мед. наук, проф., рук. университетской клиники ГБУЗ ГКБ №52; зав. каф. общей терапии фак-та ДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
俄罗斯联邦, MoscowNadija Frolova
City Clinical Hospital №52
Email: surckova.t@yandex.ru
ORCID iD: 0000-0003-3234-8266
канд. мед. наук, врач-нефролог, зам. глав. врача по нефрологической помощи ГБУЗ ГКБ №52
俄罗斯联邦, MoscowIrina Beloglazova
City Clinical Hospital №52; Pirogov Russian National Research Medical University
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-2266-1497
канд. мед. наук, врач терапевт-пульмонолог, зав. 4-м терапевтическим отд-нием ГБУЗ ГКБ №52; доц. каф. общей терапии фак-та ДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
俄罗斯联邦, MoscowZinaida Mutovina
City Clinical Hospital №52; Central State Medical Academy of the President of the Russian Federation
Email: surckova.t@yandex.ru
ORCID iD: 0000-0001-5809-6015
канд. мед. наук, доц. каф. общей терапии, кардиологии и функциональной диагностики ФГБУ ДПО ЦГМА УД Президента РФ; врач-ревматолог, зав. ревматологическим отд-нием ГБУЗ ГКБ №52
俄罗斯联邦, MoscowInna Samsonova
City Clinical Hospital №52
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-1228-1765
канд. мед. наук, зам. глав. врача по медицинской части ГБУЗ ГКБ №52
俄罗斯联邦, MoscowElena Kovalevskaja
City Clinical Hospital №52
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-0787-4347
канд. мед. наук, врач-кардиолог, зав. кардиологическим отд-нием ГБУЗ ГКБ №52
俄罗斯联邦, MoscowAlena Zagrebneva
City Clinical Hospital №52; Pirogov Russian National Research Medical University
Email: surckova.t@yandex.ru
ORCID iD: 0000-0002-3235-1425
канд. мед. наук, зав. консультативно-диагностическим отд-нием №2 ГБУЗ ГКБ №52; доц. каф. общей терапии фак-та ДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
俄罗斯联邦, MoscowSofya Serdotetckova
City Clinical Hospital №52
Email: surckova.t@yandex.ru
ORCID iD: 0000-0001-8472-1152
врач аллерголог-иммунолог консультативно-диагностического отд-ния центра аллергологии и иммунологии ГБУЗ ГКБ №52
俄罗斯联邦, MoscowAnton Chernov
City Clinical Hospital №52; Russian Medical Academy of Continuous Professional Education
Email: surckova.t@yandex.ru
ORCID iD: 0000-0001-6209-387X
врач-терапевт отд. клин. фармакологии ГБУЗ ГКБ №52; мл. науч. сотр. Научно-исследовательского института молекулярной и персонализированной медицины ФГБОУ ДПО РМАНПО
俄罗斯联邦, MoscowMaryana Lysenko
City Clinical Hospital №52; Pirogov Russian National Research Medical University
Email: surckova.t@yandex.ru
ORCID iD: 0000-0001-6010-7975
д-р мед. наук, глав. врач ГБУЗ ГКБ №52; проф. каф. общей терапии фак-та ДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
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