Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit.

Mohsen Farrokhpour,Farhad Zamani,Najmeh Moradi,Mehdi Azimi,Maryam Roham,Shahrokh Izadi,Shirin Izadi,Mitra Ranjbar,Nader Rezaie,Fatemeh Ghaffari Rad,Mahdi Yadollahzadeh,Mahin Jamshidi Makiani,Azadeh Laali

doi:10.34172/aim.2021.22

Abstract

Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

Highlights

Coronaviruses can cause a mild and limited infection in the upper respiratory tract, the gastrointestinal tract or the kidneys.[1]
According to the Iranian national and local guidelines of the multispecialty hospital up to the date, COVID-19 is treated using a standard treatment regimen based on the patient’s condition: three-drug regimen (Oseltamivir + hydroxychloroquine + lopinavir/ ritonavir or sofosbuvir); or four-drug regimen (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or atazanavir + ribavirin or sofosbuvir),[17,18] which are used for all admitted patients including those in the control group
In our study, we assessed 104 cases including 43 cases as the control group and 61 cases in three trials groups; all patients were severe COVID-19 intubated patients admitted to the intensive care unit (ICU)

Summary

Introduction

Coronaviruses can cause a mild and limited infection in the upper respiratory tract, the gastrointestinal tract or the kidneys.[1] some of them, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome–related coronavirus (MERS-CoV), could cause very severe illnesses.[2,3] In December 2019, a number of pneumonia cases were identified in Wuhan, China, for unknown reasons, leading to the identification of a new human coronavirus called coronavirus disease 2019 (COVID-19).

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