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Sci Rep . Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement

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  • Sci Rep . Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement

    Sci Rep


    . 2024 Jul 23;14(1):16985.
    doi: 10.1038/s41598-024-68013-6. Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement

    Avigayil Goldstein 1 , Ami Neuberger 2 3 , Yazeed Qassem Darawsha 4 , Khetam Hussein 3 5 , Tali Shafat 6 7 , Daniel Grupel 6 7 , Jacob Strahilevitz 8 , Sarah Israel 8 , Ariel Weil 9 , Ronen Ben-Ami 10 11 , Meital Elbaz 10 11 , Ronza Najjar-Debbiny 3 12 , Jihad Bishara 13 11 , Amir Shlomai # 14 11 , Michal Landes # 14 11



    AffiliationsAbstract

    Covid-19 disease is implicated in increased mortality among immunocompromised patients. The JAK inhibitor, baricitinib (bar), or the IL-6 inhibitor, tocilizumab (toc), demonstrated a survival benefit in patients with severe disease.However, evidence supporting their use in immunocompromised patients with severe Covid-19 is scarce.We aimed to assess clinical outcomes of bar/toc treatment in immunocompromised patients. A multi-center registry of consecutive immunocompromised patients hospitalized due to severe Covid-19 during the Omicron variant dominance period. After excluding patients who did not require high oxygen supply, patients treated with bar/toc were compared to patients treated by standard of care (SOC). Primary outcome was in hospital mortality. Secondary outcomes were 30 and 60 day mortality, super-infection and thromboembolic events. Among an overall 228 immunocompromised patients hospitalized in six Israeli hospitals with severe Covid-19, 112 patients required high oxygen support, of whom 48 (43%) were treated with bar/toc. In-hospital mortality rates were exceptionally high and did not significantly differ between bar/toc and SOC treated patients (62.5% vs. 64.1%, p = 1.0). A logistic regression analysis revealed that advanced age and incomplete vaccination were predictors of in-hospital mortality. Patients treated with bar/toc had no excess of suspected super-infection (62.8% vs. 60.7%, p = 0.84) or thromboembolic events (8.3% vs 3.1%, p = 0.39). In immunocompromised patients with severe Covid-19 and a high oxygen demand, bar/toc therapy was not associated with reduced mortality or with a higher rate of associated complications, compared to SOC. Larger prospective studies should better address efficacy and safety.

    Keywords: Covid-19; Critical disease; Immunomodulatory treatment; Immunosuppressed patients.

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