Efficacy and safety of tocilizumab in critically ill adults with COVID-19 infection in Bahrain: A report of 5 cases

ElSeirafi, Mohamed M; Hasan, Hasan Msn; Sridharan, Kannan; Zamoori, Alaa; Alkhawaja, Sana; Pasha, Sheikh Abdul Azeez

doi:10.1016/j.rmcr.2020.101139

Cited by 4 publications

(5 citation statements)

References 11 publications

(11 reference statements)

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“…Of these 28 included studies, 22 were case reports (describing single patients with individual data), two were case series (describing 7–42 patients with aggregate data), and four were cohort studies (describing 4–40 patients with aggregate data). Countries of study publication included the United States (n = 7) [ 7 , 9 , 21 – 25 ], Italy (n = 7) [ 26 – 32 ], Japan (n = 2) [ 33 , 34 ], Iran (n = 2) [ 35 , 36 ], the United Kingdom (n = 2) [ 37 , 38 ], Spain (n = 2) [ 39 , 40 ], Bahrain (n = 1) [ 41 ], China (n = 1) [ 42 ], France (n = 1) [ 43 ], the Philippines (n = 1) [ 44 ], Korea (n = 1) [ 45 ], and Canada (n = 1) [ 46 ], with publication dates ranging from April 15, 2020 to June 16, 2021. Table 1 describes the characteristics of these included studies and available information on their respective patient demographics in detail.…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

et al. 2021

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Background Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 and S. aureus co-infection. Methods A scoping review of the literature was conducted in PubMed, Scopus, Ovid MEDLINE, CINAHL, ScienceDirect, medRxiv, and the WHO COVID-19 database using a combination of terms. Articles that were in English, included patients infected with both COVID-19 and S. aureus, and provided a description of clinical outcomes for patients were eligible. From these articles, the following data were extracted: type of staphylococcal species, onset of co-infection, patient sex, age, symptoms, hospital interventions, and clinical outcomes. Quality assessments of final studies were also conducted using the Joanna Briggs Institute’s critical appraisal tools. Results Searches generated a total of 1922 publications, and 28 articles were eligible for the final analysis. Of the 115 co-infected patients, there were a total of 71 deaths (61.7%) and 41 discharges (35.7%), with 62 patients (53.9%) requiring ICU admission. Patients were infected with methicillin-sensitive and methicillin-resistant strains of S. aureus, with the majority (76.5%) acquiring co-infection with S. aureus following hospital admission for COVID-19. Aside from antibiotics, the most commonly reported hospital interventions were intubation with mechanical ventilation (74.8 %), central venous catheter (19.1 %), and corticosteroids (13.0 %). Conclusions Given the mortality rates reported thus far for patients co-infected with S. aureus and COVID-19, COVID-19 vaccination and outpatient treatment may be key initiatives for reducing hospital admission and S. aureus co-infection risk. Physician vigilance is recommended during COVID-19 interventions that may increase the risk of bacterial co-infection with pathogens, such as S. aureus, as the medical community’s understanding of these infection processes continues to evolve.

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Section: Resultsmentioning

confidence: 99%

Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

et al. 2021

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“…The IL-6 effect on I Kr is mediated through binding to IL-6R which interacts with membrane-bound gp130 and its downstream Janus-kinase signaling pathways 28 , 43 . In support of the role of proinflammatory IL-6 in COVID-19 patients, TCZ which is a recombinant humanized monoclonal anti-IL-6R antibody approved by FDA for the treatment of severe or life-threatening chimeric antigen-receptor-T-cell-induced cytokine release syndrome 44 , is being tested in COVID-19 patients 21 – 24 . Our data demonstrating that TCZ prevented the electrocardiographic abnormalities induced by IL-6 + AZM + HCQ suggest that targeting key molecules within the inflammatory cytokine storm such as IL-6, could be a novel strategy for limiting the direct electrophysiological and arrhythmogenic effects of IL-6 in COVID-19 patients 26 and beyond.…”

Section: Discussionmentioning

confidence: 99%

Arrhythmogenic mechanisms of interleukin-6 combination with hydroxychloroquine and azithromycin in inflammatory diseases

Xihua

Wang

Xiao

et al. 2022

Sci Rep

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Inflammatory diseases including COVID-19 are associated with a cytokine storm characterized by high interleukin-6 (IL-6) titers. In particular, while recent studies examined COVID-19 associated arrhythmic risks from cardiac injury and/or from pharmacotherapy such as the combination of azithromycin (AZM) and hydroxychloroquine (HCQ), the role of IL-6 per se in increasing the arrhythmic risk remains poorly understood. The objective is to elucidate the electrophysiological basis of inflammation-associated arrhythmic risk in the presence of AZM and HCQ. IL-6, AZM and HCQ were concomitantly administered to guinea pigs in-vivo and in-vitro. Electrocardiograms, action potentials and ion-currents were analyzed. IL-6 alone or the combination AZM + HCQ induced mild to moderate reduction in heart rate, PR-interval and corrected QT (QTc) in-vivo and in-vitro. Notably, IL-6 alone was more potent than the combination of the two drugs in reducing heart rate, increasing PR-interval and QTc. In addition, the in-vivo or in-vitro combination of IL-6 + AZM + HCQ caused severe bradycardia, conduction abnormalities, QTc prolongation and asystole. These electrocardiographic abnormalities were attenuated in-vivo by tocilizumab (TCZ), a monoclonal antibody against IL-6 receptor, and are due in part to the prolongation of action potential duration and selective inhibition of Na+, Ca2+ and K+ currents. Inflammation confers greater risk for arrhythmia than the drug combination therapy. As such, in the setting of elevated IL-6 during inflammation caution must be taken when co-administering drugs known to predispose to fatal arrhythmias and TCZ could be an important player as a novel anti-arrhythmic agent. Thus, identifying inflammation as a critical culprit is essential for proper management.

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“…Our results showed that neither seemed to significantly affect the rate of AKI. An explanation might be that these are therapies of last resort in severe and critical cases wherein the pathology of AKI is ongoing and difficult to reverse [ 20 , 28 ]. More extensive observational studies and controlled trials are needed to find associations between each of these treatments and the development of AKI in COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain

Taher¹,

Alalwan²,

Naser³

et al. 2020

Cureus

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Background Kidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality. Methods This retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI. Results The mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO 2 /FiO 2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma. Conclusions The rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.

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Efficacy and safety of tocilizumab in critically ill adults with COVID-19 infection in Bahrain: A report of 5 cases

Cited by 4 publications

References 11 publications

Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

Arrhythmogenic mechanisms of interleukin-6 combination with hydroxychloroquine and azithromycin in inflammatory diseases

Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain

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