First Report of Tocilizumab Use in a Cohort of Latin American Patients Hospitalized for Severe COVID-19 Pneumonia

Valenzuela, Omar; Ibáñez, Sebastian; Poli, Cecilia; Roessler, Patricia; Aylwin, Mabel; Roizen, Gigia; Iruretagoyena, Mirentxu; Agar, Vivianne; Donoso, Javiera; Fierro, Margarita; Montes, José Miguel

doi:10.3389/fmed.2020.596916

Cited by 5 publications

(2 citation statements)

References 27 publications

(30 reference statements)

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“…Similar to steroids, tocilizumab has strong anti-in ammatory properties as a neutralizing monoclonal antibody against the human IL-6 receptor. Early studies during the rst surge of the pandemic showed a bene t of tocilizumab by reducing mortality in critically ill COVID-19 patients suffering from hyperin ammation and respiratory failure (40,41). However, these bene cial effects postulated for tocilizumab were refuted in subsequent large-scale studies which failed to demonstrate the e cacy of tocilizumab in reducing mortality in critically ill patients with COVID-19 (42,43).…”

Section: Discussionmentioning

confidence: 99%

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Delgado

Cornett²,

Choi³

et al. 2023

Preprint

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Background: The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based treatment recommendations. The empirical modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the “emergency use authorization” paradigm by regulatory agencies. This study was designed to evaluate the insights from the “fail-and-learn” strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials. Methods: A retrospective, multicenter, propensity-matched, case-control study was performed on a data registry comprising 186 hospitals from a national health care system in the United States, designed to investigate the efficacy of empirical treatment modalities during the early surge of the COVID-19 pandemic in 2020. Reflective of the time-windows of the initial two surges of the pandemic in 2020, patients were stratified into “early” (March 1–June 30) versus “late” (July 1–December 31) study cohorts. Logistic regression was applied to determine the efficacy of prevalent medications (remdesivir, azithromycin, hydroxychloroquine, corticosteroids, tocilizumab) and supplemental oxygen delivery modalities (invasive vs. non-invasive ventilation) on patient outcomes. The primary outcome measure was in-hospital mortality. Group comparisons were adjusted for covariates related to age, gender, ethnicity, body weight, comorbidities, and treatment modalities pertinent to organ failure replacement. Results: From a total of 87,788 patients in the multicenter data registry screened in this study, 9,638 patients were included who received 19,763 COVID-19 medications during the first two waves of the 2020 pandemic.The results showed inconclusive variable results pertinent to the impact of empirical medications on patient outcomes. In contrast, the necessity for oxygen supply showed significantly increased odds of mortality beyond the effect of the investigational medications. Of all the covariates associated with increased mortality, invasive mechanical ventilation had the highest odds ratios of 8.34 in the first surge and 9.46 in in the second surge of the pandemic (P<0.01). Conclusion: This retrospective multicenter observational cohort study on 9,638 hospitalized patients with severe COVID-19 during revealed that the necessity for invasive ventilation had the highest odds of mortality, beyond the variable effects observed by administration of the prevalent EUA-approved investigational drugs during the first two surges of the early 2020 pandemic in the United States.

show abstract

Section: Discussionmentioning

confidence: 99%

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Delgado

Cornett²,

Choi³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Similar to steroids, tocilizumab has strong anti-inflammatory properties as a neutralizing monoclonal antibody against the human IL-6 receptor. Early studies during the first surge of the pandemic showed a benefit of tocilizumab by reducing mortality in critically ill COVID-19 patients suffering from hyperinflammation and respiratory failure [ 40 , 41 ]. However, these beneficial effects postulated for tocilizumab were refuted in subsequent large-scale studies which failed to demonstrate the efficacy of tocilizumab in reducing mortality in critically ill patients with COVID-19 [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Delgado

Cornett²,

Choi³

et al. 2023

Patient Saf Surg

View full text Add to dashboard Cite

Background The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based recommendations. The empirical treatment modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the “emergency use authorization” (EUA) paradigm by regulatory agencies. This study was designed to evaluate the insights from the “fail-and-learn” strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials. Methods A retrospective, multicenter, propensity-matched, case-control study was performed on a data registry comprising 186 hospitals from a national health care system in the United States, designed to investigate the efficacy of empirical treatment modalities during the early surge of the COVID-19 pandemic in 2020. Reflective of the time-windows of the initial two surges of the pandemic in 2020, patients were stratified into “Early 2020” (March 1–June 30) versus “Late 2020” (July 1–December 31) study cohorts. Logistic regression was applied to determine the efficacy of prevalent medications (remdesivir, azithromycin, hydroxychloroquine, corticosteroids, tocilizumab) and supplemental oxygen delivery modalities (invasive vs. non-invasive ventilation) on patient outcomes. The primary outcome measure was in-hospital mortality. Group comparisons were adjusted for covariates related to age, gender, ethnicity, body weight, comorbidities, and treatment modalities pertinent to organ failure replacement. Results From a total of 87,788 patients in the multicenter data registry screened in this study, 9,638 patients were included who received 19,763 COVID-19 medications during the first two waves of the 2020 pandemic. The results showed a minimal, yet statistically significant, association with hydroxychloroquine in “Early 2020” and remdesivir in “Late 2020” with reduced odds of mortality (odds ratios 0.72 and 0.76, respectively; P = 0.01). Azithromycin was the only medication associated with decreased odds of mortality during both study time-windows (odds ratios 0.79 and 0.68, respectively; P < 0.01). In contrast, the necessity for oxygen supply showed significantly increased odds of mortality beyond the effect of all investigated medications. Of all the covariates associated with increased mortality, invasive mechanical ventilation had the highest odds ratios of 8.34 in the first surge and 9.46 in in the second surge of the pandemic (P < 0.01). Conclusion This retrospective multicenter observational cohort study on 9,638 hospitalized patients with severe COVID-19 during revealed that the necessity for invasive ventilation had the highest odds of mortality, beyond the variable effects observed by administration of the prevalent EUA-approved investigational drugs during the first two surges of the early 2020 pandemic in the United States.

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Applications of nanomaterials in COVID-19 pandemic

Xiao

Zeng

et al. 2021

Rare Met.

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Graphical abstract The novel coronavirus 2019 (COVID-19) pandemic represents one of the biggest global health threats in the last two decades, so researchers around the world are searching for solutions and treatments for COVID-19. At the time of writing, there are no specific drugs that have demonstrated suitable effectiveness in treating COVID-19. The current challenge involves designing tools for the prevention, rapid and accurate diagnosis, drug delivery, and effective treatment of this novel coronavirus. In this short review, we discuss how nanotechnology offers new ways to combat COVID-19, and how nanomaterials can be applied to control the COVID-19 outbreak. We also summarize relevant studies regarding the use of nanomaterials for preventing viral spread, preparing vaccines, and diagnosing coronavirus, as well as studies that show how nanoparticles can be used as drug delivery systems for the treatment of viral infections. Research on nanotechnology-based diagnosis, drug delivery, and antiviral therapy is currently in the early stages. However, the unique chemical properties of some nanomaterials highlight the broad prospect of nanomaterials in the future, and we propose that they will play an important role in the fight against COVID-19.

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First Report of Tocilizumab Use in a Cohort of Latin American Patients Hospitalized for Severe COVID-19 Pneumonia

Cited by 5 publications

References 27 publications

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the “fail-and-learn” strategy during the first two waves of the pandemic in 2020

Applications of nanomaterials in COVID-19 pandemic

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