Efficacy and secondary infection risk of tocilizumab, sarilumab and anakinra in COVID‐19 patients: A systematic review and meta‐analysis

Peng, Jingwen; Fu, Meihua; Mei, Huan; Zheng, Hailin; Liang, Guanzhao; She, Xiaodong; Wang, Qiong; Liu, Weida

doi:10.1002/rmv.2295

Cited by 61 publications

(42 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies have shown that anakinra treatment can significantly reduce mortality in COVID-19 patients without increasing the risk of infection and with no side effects. Anakinra is therefore an ideal broad-spectrum therapeutic drug [ 123 , 124 ]. In a recent study, 10 hospitalized adults with bilateral pneumonia, excessive inflammation, and respiratory failure who did not require mechanical ventilation showed a rapid decrease in serum CRP, improved oxygenation, and no granulocytopenia or bacterial septicemia during 45 days of hospitalization when treated with canakinumab [ 125 ].…”

Section: Treatmentmentioning

confidence: 99%

Potential Pathophysiological Mechanisms Underlying Multiple Organ Dysfunction in Cytokine Release Syndrome

Chen

Tang

et al. 2022

Mediators of Inflammation

View full text Add to dashboard Cite

In recent decades, many serious respiratory infections have broken out all over the world, including SARS-CoV, MERS, and COVID-19. They are characterized by strong infectivity, rapid disease progression, high mortality, and poor prognosis. Excessive immune system activation results in cytokine hypersecretion, which is an important reason for the aggravation of symptoms, and can spread throughout the body leading to systemic multiple organ dysfunction, namely, cytokine release syndrome (CRS). Although many diseases related to CRS have been identified, the mechanism of CRS is rarely mentioned clearly. This review is intended to clarify the pathogenetic mechanism of CRS in the deterioration of related diseases, describe the important signaling pathways and clinical pathophysiological characteristics of CRS, and provide ideas for further research and development of specific drugs for corresponding targets to treat CRS.

show abstract

Section: Treatmentmentioning

confidence: 99%

Potential Pathophysiological Mechanisms Underlying Multiple Organ Dysfunction in Cytokine Release Syndrome

Chen

Tang

et al. 2022

Mediators of Inflammation

View full text Add to dashboard Cite

show abstract

“…Moreover, despite poor evidence regarding the matter, a significant number of patients is treated with empiric broad-spectrum antibiotic therapy, thus increasing the risk of developing infections caused by multidrug-resistant (MDR) pathogens [ 7 ]. Lastly, the use of drugs targeting cytokines such as IL-6 in patients with the so-called COVID-19-related “cytokine storm” also may constitute a risk factor for superinfection by compromising the immune system [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19?

et al. 2022

View full text Add to dashboard Cite

The COVID-19 pandemic may have had an effect on antimicrobial resistance. We compared the prevalence of ESKAPE multidrug-resistant (MDR) bacterial infections in COVID-19 affected/unaffected patients admitted to intensive care units (ICU) or infectious disease units at the “Mater Domini” University Hospital of Catanzaro between 1 March 2020 and 31 July 2021. Moreover, an analysis of MDR rates in ICU comparing the pre-pandemic period with the pandemic period was performed, and the possible consequence on in-hospital mortality was explored. One hundred and eighty-four ESKAPE isolates were analyzed from 362 SARS-CoV-2 positive and 199 negative patients. In total, 116 out of 171 Gram-negative isolates were classified as MDR, and a higher frequency was observed in COVID-19 compared with non-COVID-19 patients (74.2% vs. 60.3%; p = 0.052). A higher rate of MDR ESKAPE bacteria was observed in COVID-19 patients admitted to the ICU compared with COVID-19 unaffected patients admitted to the same ward in 2019 (88% vs. 80.4%; p = 0.186). Acinetobacter baumannii was the main pathogen in COVID-19 patients (58.7%), where it was the most frequent cause of bloodstream infection with the highest mortality rate (68.7%). Increase in MDR appeared to be associated with COVID-19 but only in the ICU setting. Acinetobacter baumannii was associated with the risk of death, indicating the importance of implementing infection control measures urgently.

show abstract

“…Others have raised similar concerns. 4 A meta-analysis by Peng et al identified an increased risk of fungal infections (odds ratio, 2.02), 10 and a large retrospective study is underway to further describe infection risks associated with tocilizumab (https:// clinicaltrials.gov/ct2/show/NCT05017441).…”

Section: Discussionmentioning

confidence: 99%

Secondary Infection Risk in Patients With Severe COVID-19 Pneumonia Treated With Tocilizumab

Sandhu

Piraino

Piticaru

2022

American Journal of Therapeutics

View full text Add to dashboard Cite

Background: Severe SARS-CoV-2 (COVID) pneumonia is characterized by marked inflammation. Current guidelines recommend the addition of the tocilizumab to dexamethasone in critically ill patients. In randomized trials, the use of tocilizumab was not associated with a statistically significant increased risk of secondary infections but concerns remain.Study Question: Do patients with severe COVID pneumonia treated with tocilizumab experienced high rates of secondary infection.Study Design: We performed a retrospective electronic chart review of patients with COVID pneumonia who received tocilizumab and dexamethasone (n 5 62) from January 2021 to October 2021 and compared them with a cohort of patients (n 5 49) who received only dexamethasone and admitted from July 2020 to December 2020 (before institutional use of tocilizumab). Patients received tocilizumab only if they had acute hypoxic respiratory failure and were felt to be clinically worsening. Patients were deemed to have a secondary infection only if a diagnosis of infection was confirmed via positive cultures.Results: Sixty-six patients received tocilizumab; of which, 30 (45.5%) subsequently had culturepositive secondary infections compared with 24.5% of controls. Thirty-one patients (47.0%) who received tocilizumab died by the time of analysis, 14 (45.2%) of whom had a secondary infection. Gram-negative bacterial infections predominated, followed by fungal infections. Patients who received tocilizumab had over twice as many gram-negative pneumonias (30.3% vs. 14.3%).Conclusions: Patients with severe COVID pneumonia treated with tocilizumab experienced high rates of secondary infection. Although the benefit of tocilizumab in reducing mortality is wellestablished and almost certainly outweighs secondary infection risks, we question if the "real-world" infection rates are much higher than those reported in trials or if the infection risk could be mitigated with dose reductions in tocilizumab without losing the mortality benefit. Further study into the infection risk, and risk-benefit analysis of dose adjustments, of tocilizumab in the critical care setting is warranted.

show abstract

Efficacy and secondary infection risk of tocilizumab, sarilumab and anakinra in COVID‐19 patients: A systematic review and meta‐analysis

Cited by 61 publications

References 29 publications

Potential Pathophysiological Mechanisms Underlying Multiple Organ Dysfunction in Cytokine Release Syndrome

Potential Pathophysiological Mechanisms Underlying Multiple Organ Dysfunction in Cytokine Release Syndrome

Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19?

Secondary Infection Risk in Patients With Severe COVID-19 Pneumonia Treated With Tocilizumab

Contact Info

Product

Resources

About