Murat ACAT, Bengisu Pınar ACAT, Özben ÇAVDAR, Ahmet TEZCE

COVID-19 Tedavisinde Tocilizumab ve Anakinra’nın Karşılaştırılması: Tek Merkez Deneyimi

Amaç: Bu çalışmanın amacı anakinra ve tocilizumab tedavisi alan ağır ve kritik koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) hastalarında; endotrakeal entübasyon, non-invaziv mekanik ventilasyon, yüksek akım oksijen tedavisi gereksinimleri ve 28 günlük mortalite oranları arasında bir farklılık olup olmadığının araştırılmasıdır. Gereç ve Yöntemler: Bu geriye dönük çalışmaya, Nisan 2020 ile Mart 2021 tarihleri arasında Karabük Eğitim ve Araştırma Hastanesi'nde tocilizumab ve anakinra ile tedavi edilmiş olan COVID-19 ile enfekte 70 hasta dahil edildi. Hastaların demografik özellikleri, komorbiditeler, tedaviler, hastaların klinik sonuçları ve hemogram bulguları ile ilgili veriler hastane kayıtlarından alındı. Bulgular: Hastaların ortalama yaşı 61,34±11,8 yıl idi. 70 hastanın 12 (%17,1)’si kadın ve 58 (%82,9)’i erkekti. Ağır ve kritik COVID-19 vakası sırasıyla 48 (%68,6) hastada ve 22 (%31,4) hastada görüldü. Tocilizumab ve anakinra grupları arasında; 28 gündeki mortalite oranı istatistiksel olarak anlamlı şekilde farklı değildi (p=0,999). Yüksek akım oksijen tedavisi ve non-invaziv mekanik ventilasyon gereksinimlerinin her ikisi de tocilizumab grubunda anakinra grubundan daha düşük (sırasıyla p<0,001 ve p=0,002) iken entübasyon ihtiyacı bakımından iki grup arasında istatistiksel olarak anlamlı bir farklılık yoktu (p=0,999). Tocilizumab grubunda hastanede kalış süresi de anlamlı olarak daha kısaydı (p=0,027). Sonuç: Tocilizumab grubunda yüksek akım oksijen tedavisi, non-invaziv mekanik ventilasyon gereksinimleri ve hastanede kalış süresi anakinra grubuna göre anlamlı derecede daha düşüktür. COVID-19'da sitokin fırtınası, aşırı inflamatuar yanıt, ciddi hastalık seyrine neden olmakta ve prognozu kötüleştirmektedir.

Anahtar Kelimeler:

anakinra, covid-19, tocilizumab

Comparison of Tocilizumab and Anakinra in the Treatment of COVID-19: A Single-Center Experience

Aim: The aim of this study was to examine whether a difference between endotracheal intubation, non-invasive mechanical ventilation, high flow oxygen therapy requirements and 28-day mortality rate in severe and critical coronavirus disease 2019 (COVID-19) patients receiving anakinra and tocilizumab treatment. Material and Methods: A total of 70 patients infected with COVID-19, who were treated with tocilizumab and anakinra from April 2020 to March 2021 at Karabük Training and Research Hospital, were recruited in this retrospective study. Data on patient demographics, comorbidities, treatments, clinical outcomes of the patients’ and hemogram findings were retrieved from hospital records. Results: The mean age of the patients was 61.34±11.8 years. Of the 70 patients, 12 (17.1%) were female and 58 (82.9%) were male. Severe and critical COVID-19 cases were evident in 48 (68.6%), and 22 (31.4%) patients, respectively. The mortality rate in 28 days was not statistically significantly different between the tocilizumab and anakinra groups (p=0.999). Both the necessity of high flow oxygen therapy and non-invasive mechanical ventilation were lower in the tocilizumab group than in the anakinra group (p<0.001, and p=0.002, respectively), while there was no statistically significant difference in the necessity of intubation between the two groups (p=0.999). The length of stay was also significantly shorter in the tocilizumab group (p=0.027). Conclusion: High flow oxygen therapy, non-invasive mechanical ventilation requirements, and length of stay were significantly lower than anakinra in the tocilizumab group. Excessive inflammatory response with cytokine storm features causes severe disease course and worsens prognosis in COVID-19.

Keywords:

anakinra, covid-19, tocilizumab,

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