tetano
Editor, Senior Moderator
Respirol Case Rep
. 2021 Mar 7;9(4):e0733.
doi: 10.1002/rcr2.733. eCollection 2021 Apr.
Multimodality treatment in immunocompromised patients with severe COVID-19: the role of IL-6 inhibitor, intravenous immunoglobulin, and haemoperfusion
Nophol Leelayuwatanakul[SUP] 1 [/SUP], Napplika Kongpolprom[SUP] 1 [/SUP], Thitiwat Sriprasart[SUP] 1 [/SUP], Vorakamol Phoophiboon[SUP] 1 [/SUP], Vorawut Thanthitaweewat[SUP] 1 [/SUP], Sarita Thawanaphong[SUP] 1 [/SUP], Worawan Sirichana[SUP] 1 [/SUP], Naricha Chirakalwasan[SUP] 1 [/SUP], Kamon Kawkitinarong[SUP] 1 [/SUP], Chanchai Sittipunt[SUP] 1 [/SUP], Opass Putcharoen[SUP] 2 3 [/SUP], Leilani Paitoonpong[SUP] 2 3 [/SUP], Gompol Suwanpimolkul[SUP] 2 3 [/SUP], Watsamon Jantarabenjakul[SUP] 3 4 [/SUP], Nattachai Srisawat[SUP] 5 [/SUP], Monvasi Pachinburavan[SUP] 1 [/SUP]
Affiliations
Abstract
Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID-19). Multiple anti-inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life-threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID-19-related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO[SUB]2[/SUB]:FiO[SUB]2[/SUB] ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID-19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.
Keywords: COVD?19; IVIG; SARS?CoV?2; haemoperfusion; tocilizumab.
. 2021 Mar 7;9(4):e0733.
doi: 10.1002/rcr2.733. eCollection 2021 Apr.
Multimodality treatment in immunocompromised patients with severe COVID-19: the role of IL-6 inhibitor, intravenous immunoglobulin, and haemoperfusion
Nophol Leelayuwatanakul[SUP] 1 [/SUP], Napplika Kongpolprom[SUP] 1 [/SUP], Thitiwat Sriprasart[SUP] 1 [/SUP], Vorakamol Phoophiboon[SUP] 1 [/SUP], Vorawut Thanthitaweewat[SUP] 1 [/SUP], Sarita Thawanaphong[SUP] 1 [/SUP], Worawan Sirichana[SUP] 1 [/SUP], Naricha Chirakalwasan[SUP] 1 [/SUP], Kamon Kawkitinarong[SUP] 1 [/SUP], Chanchai Sittipunt[SUP] 1 [/SUP], Opass Putcharoen[SUP] 2 3 [/SUP], Leilani Paitoonpong[SUP] 2 3 [/SUP], Gompol Suwanpimolkul[SUP] 2 3 [/SUP], Watsamon Jantarabenjakul[SUP] 3 4 [/SUP], Nattachai Srisawat[SUP] 5 [/SUP], Monvasi Pachinburavan[SUP] 1 [/SUP]
Affiliations
- PMID: 33732466
- PMCID: PMC7938208
- DOI: 10.1002/rcr2.733
Abstract
Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID-19). Multiple anti-inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life-threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID-19-related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO[SUB]2[/SUB]:FiO[SUB]2[/SUB] ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID-19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.
Keywords: COVD?19; IVIG; SARS?CoV?2; haemoperfusion; tocilizumab.