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[616.98:578.834.1]-085.2 (1) |
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SM ISO690:2012 COJOCARU, Stela, RUSSU, Irina, BUTA, Galina, BERSAN, Sebastian, POTÎNG-RAŞCOV, Valentina, CULIUC, Natalia, BABA, Lilia. A reduced fixed dose of tocilizumab 200 mg compared to 400 mg in patients with severe COVID-19 disease. In: One Health and Risk Management, 2023, nr. 4(4), pp. 19-26. ISSN 2587-3458. DOI: https://doi.org/10.38045/ohrm.2023.4.02 |
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One Health and Risk Management | ||||||
Numărul 4(4) / 2023 / ISSN 2587-3458 /ISSNe 2587-3466 | ||||||
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DOI:https://doi.org/10.38045/ohrm.2023.4.02 | ||||||
CZU: [616.98:578.834.1]-085.2 | ||||||
Pag. 19-26 | ||||||
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Introduction. Excessive, deregulated pro-inflammatory cytokine secretion has a detrimental impact on the evolution of COVID-19, aggregating the tissue impairment, organ failure, and an increased risk of death. Several studies have demonstrated the beneficial effect of Tocilizumab (TCZ) in reducing hyperimmune response in severe forms of COVID-19. Material and methods. This is an experimental controlled clinical trial, consisting of 66 patients hospitalized with severe COVID-19. Results. On overage, the decision to administer TCZ was made on average on the 11.34±0.31 day of the disease, when the beginning of Cytokine Storm was suspected in the patients already on dexamethasone treatment. The clinical and paraclinical parameters, including fever, asthenia and dyspnea duration, SpO2 level, oxygen therapy need, improvement of the radiological picture, and duration of hospitalization were more favorable in patients treated with TCZ 400 mg compared to those treated with TCZ 200 mg (p<0.0001). The relative risk of rapid worsening after TCZ (RR=0.88), the relative risk of decreasing blood pressure (RR=0.29) and the relative risk of transfer to intensive care units for invasive or non-invasive ventilation (RR=0.8) was lower in patients treated with TCZ 200 mg compared to the 400 mg TCZ lot. Conclusions. The dose of TCZ had a significant impact on the duration of clinical manifestations, the duration of oxygen therapy and the duration of patient hospitalization, with better results for TCZ 400 mg compared to TCZ 200 mg. Although the risk of worsening after TCZ and the risk of transfer to intensive care were lower in patients treated with TCZ 200 mg. So, the 200 mg fixed dose of TCZ can be a life-saving option for severely ill patients with COVID-19 in the context of IL-6 inhibitor supply shortages. |
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Cuvinte-cheie COVID-19, cytokine storm, Tocilizumab, severe forms, oxygen therapy, COVID-19, furtună de citokine, tocilizumab, forme severe, terapie cu oxigen |
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<?xml version='1.0' encoding='utf-8'?> <resource xmlns:xsi='http://www.w3.org/2001/XMLSchema-instance' xmlns='http://datacite.org/schema/kernel-3' xsi:schemaLocation='http://datacite.org/schema/kernel-3 http://schema.datacite.org/meta/kernel-3/metadata.xsd'> <identifier identifierType='DOI'>10.38045/ohrm.2023.4.02</identifier> <creators> <creator> <creatorName>Cojocaru, S.E.</creatorName> <affiliation>Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Russu, I.</creatorName> <affiliation>Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Buta, G.V.</creatorName> <affiliation>Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Bersan, S.</creatorName> <affiliation>Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Potîng-Raşcov, V.</creatorName> <affiliation>Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Culiuc, N.</creatorName> <affiliation>Spitalul Clinic Republican de Boli Infecţioase „Toma Ciorbă“, Moldova, Republica</affiliation> </creator> <creator> <creatorName>Baba, L.</creatorName> <affiliation>Spitalul Clinic Republican de Boli Infecţioase „Toma Ciorbă“, Moldova, Republica</affiliation> </creator> </creators> <titles> <title xml:lang='en'>A reduced fixed dose of tocilizumab 200 mg compared to 400 mg in patients with severe COVID-19 disease</title> </titles> <publisher>Instrumentul Bibliometric National</publisher> <publicationYear>2023</publicationYear> <relatedIdentifier relatedIdentifierType='ISSN' relationType='IsPartOf'>2587-3458</relatedIdentifier> <subjects> <subject>COVID-19</subject> <subject>cytokine storm</subject> <subject>Tocilizumab</subject> <subject>severe forms</subject> <subject>oxygen therapy</subject> <subject>COVID-19</subject> <subject>furtună de citokine</subject> <subject>tocilizumab</subject> <subject>forme severe</subject> <subject>terapie cu oxigen</subject> <subject schemeURI='http://udcdata.info/' subjectScheme='UDC'>[616.98:578.834.1]-085.2</subject> </subjects> <dates> <date dateType='Issued'>2023-09-30</date> </dates> <resourceType resourceTypeGeneral='Text'>Journal article</resourceType> <descriptions> <description xml:lang='en' descriptionType='Abstract'><p>Introduction. Excessive, deregulated pro-inflammatory cytokine secretion has a detrimental impact on the evolution of COVID-19, aggregating the tissue impairment, organ failure, and an increased risk of death. Several studies have demonstrated the beneficial effect of Tocilizumab (TCZ) in reducing hyperimmune response in severe forms of COVID-19. Material and methods. This is an experimental controlled clinical trial, consisting of 66 patients hospitalized with severe COVID-19. Results. On overage, the decision to administer TCZ was made on average on the 11.34±0.31 day of the disease, when the beginning of Cytokine Storm was suspected in the patients already on dexamethasone treatment. The clinical and paraclinical parameters, including fever, asthenia and dyspnea duration, SpO2 level, oxygen therapy need, improvement of the radiological picture, and duration of hospitalization were more favorable in patients treated with TCZ 400 mg compared to those treated with TCZ 200 mg (p<0.0001). The relative risk of rapid worsening after TCZ (RR=0.88), the relative risk of decreasing blood pressure (RR=0.29) and the relative risk of transfer to intensive care units for invasive or non-invasive ventilation (RR=0.8) was lower in patients treated with TCZ 200 mg compared to the 400 mg TCZ lot. Conclusions. The dose of TCZ had a significant impact on the duration of clinical manifestations, the duration of oxygen therapy and the duration of patient hospitalization, with better results for TCZ 400 mg compared to TCZ 200 mg. Although the risk of worsening after TCZ and the risk of transfer to intensive care were lower in patients treated with TCZ 200 mg. So, the 200 mg fixed dose of TCZ can be a life-saving option for severely ill patients with COVID-19 in the context of IL-6 inhibitor supply shortages.</p></description> <description xml:lang='en' descriptionType='Abstract'><p>Introducere. Eliberarea excesivă a citokinelor proinflamatorii are un impact negativ asupra evoluției infecției COVID-19, sporind afectarea tisulară, insuficiența organică și riscul de deces. Mai multe studii au demonstrat efectul benefic al preparatului Tocilizumab (TCZ) în reducerea răspunsului hiperimun în formele severe de infecție COVID-19. Material și metode. Este un studiu experimental, clinic controlat, care include 66 pacienți, internați cu forme severe de infecție COVID-19. Rezultate. Decizia privind administrarea de TCZ a fost luată în medie în ziua a 11,34±0,31 de boală, când a fost suspectat debutul furtunii de citokine la pacienții aflați deja în tratament cu dexametazonă. Parametri clinici și paraclinici, precum durata febrei, asteniei și a dispneei, nivelul SpO2, necesitatea în terapie cu oxigen, ameliorarea tabloului imagistic radiologic, și durata spitalizării au fost mai favorabili la pacienții tratați cu TCZ 400 mg față de cei tratați cu TCZ 200 mg (p<0.0001). Riscul relativ de agravare rapidă după administrarea TCZ (RR=0,88), riscul relativ de diminuare a tensiunii arteriale (RR=0,29) și riscul relativ de transfer în secțiile de terapie intensivă pentru ventilație invazivă sau non-invazivă (RR=0,8) a fost mai scăzut la pacienții tratați cu TCZ 200 mg, comparativ cu lotul TCZ 400 mg. Concluzii. Doza de TCZ a influențat durata manifestărilor clinice, durata terapiei cu oxigen și durata spitalizării pacienților, cu rezultate mai bune pentru TCZ 400 mg față de TCZ 200 mg, deși riscul de agravare după TCZ și riscul de transfer în terapie intensivă au fost mai joase la pacienții tratați cu TCZ 200 mg. Deci, doza de TCZ de 200 mg poate fi o opțiune de salvare a vieții pacienților gravi cu infecție COVID-19, în contextul deficitului de aprovizionare cu inhibitori de IL-6.</p></description> </descriptions> <formats> <format>application/pdf</format> </formats> </resource>