Introduction/objectives: An interleukin-6 inhibition strategy could be effective in selected COVID-19 patients. The objective is to present our experience of tocilizumab use in patients with severe COVID-19. Methods: Observational retrospective cohort study. Hospitalized patients were evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with progressive ventilatory impairment and evidence of a hyperinflammatory state despite usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg), in addition to standard treatment. The use and time of use of mechanical ventilation (MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) and of inflammation laboratory parameters after 72 h of tocilizumab use was evaluated. Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and 34.5% had hypertension. Of the 20 patients who were not on MV when receiving tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them required intubation. A-a gradient, PaO 2 /FiO 2 , and inflammation parameters improved significantly. A better lymphocyte count, which improved significantly after tocilizumab use, was significantly associated with less use of MV. Five patients presented positive culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte count was associated with having a positive culture. No other significant adverse events were seen. Conclusion: Our study suggests the utility and shows the safety of tocilizumab use in COVID-19 patients who have respiratory failure and evidence of hyperinflammation. Lymphocyte improvement was a predictor of good response.
BackgroundPulmonary diseases associated to a rheumatologic condition constitute a heterogeneous group of pathologies that are grouped according to their clinical and radiological similarity. There is a perception that the incidence of these diseases has been increasing, however, in Chile, there are no up-to-date publications regarding the characteristics of this group of patients.ObjectivesTo describe and characterize patients with pulmonary disease associated to a rheumatologic diagnosis at Hospital Padre Hurtado, Chile, between the years 2014 and 2016.MethodsPatients with suspected lung involvement associated to a connective tissue disease were evaluated by a bronchopulmonar specialist and a rheumatologist in a joint polyclinic. If the diagnosis was confirmed by the specialist the patient was included in the database. Data collected included age, gender, rheumatologic diagnosis and radiological pattern.Results76 patients were included. 85.5% were female. The mean age was 58 years. Eighty-nine percent of the patients came from the Rheumatology department. These patients developed respiratory symptoms during the course of their disease. The remaining 11% were patients controlled in the Pulmonary diseases department, and the respiratory symptoms were the first manifestation of their conective tissue disease.The rheumatologic diagnoses that were concluded in this multidisciplinary polyclinic were distributed as described in Table 1.69.7% of the patients have completed the radiological evaluation (Table 2).Table 1.Rheumatologic diagnosis of 76 patientsRheumatoid Arthritis (%)31 (40.8)Scleroderma (%)8 (10.5)Inflammatory Myopathy (%)5 (6.6)Sjögren Syndrome (%)5 (6.6)Systemic Lupus Erythematosus (%)4 (5.3)Undifferentiated Connective Tissue Disease (%)3 (3.9)Mixed Connective Tissue Disease (%)3 (3.9)Recurrent Polychondritis (%)2 (2.6)Other diagnosis (%)15 (19.7)Table 2.Radiological evaluation of 53 patientsInterstitial Lung Disease pattern: Non Usual Interstitial Pneumonia (%)26 (49.1)Interstitial Lung Disease pattern: Usual Interstical Pneumonia (%)8 (15.1)Bronchiolitis (%)6 (11.3)Emphysema (%)5 (9.4)Nodules (%)3 (5.7)Pulmonary embolism (%)2 (3.8)Bronchiectasis (%)1 (1.9)Sarcoidosis (%)1 (1.9)Tracheal stenosis (%)1 (1.9)ConclusionsHaving a multidisciplinary clinical unit allowed us to order and protocolize the study, follow-up and treatment of the patients with lung involvement associated with a connective tissue disease. Currently, the multidisciplinary management of these patients is indispensable, as described in the literature.Disclosure of InterestNone declared
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