Ali AKIN, Yılmaz SAFİ, Talat Soner YILMAZ

COVID-19’a Bağlı Sitokin Fırtınasında Anakinra ve Tosilizumab Tedavilerinin Karşılaştırılması

Amaç: Koronavirüs-19 hastalığına (COVID-19) bağlı gelişen sitokin fırtınasının (SF) mortalite ve morbiditeyi etkilemede önemli olduğu düşünülmektedir. Çalışmamızda yoğun bakım kliniğinde SF nedenli yatan hastalarda tosilizumab ile anakinranın etkinliklerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Ocak 2021-Aralık 2021 tarihleri arasında SF gelişen 69 hasta alındı. Anakinra veya tosilizumab tedavisi alan hastaların aldıkları tedavi süreleri ve dozları, daha önce aldıkları tedaviler (favipiravir ve pulse steroid) kayıt altına alındı. Hastaların biyokimyasal parametreleri retrospektif olarak incelendi. Bulgular: Sitokin fırtınası olan olguların 42’si (% 60,9) anakinra, 27’si (% 39,1) tosilizumab kullanmıştı. Olguların % 39,1’i (n=27) kadın, % 60,9’u (n=42) erkekti. Olguların yaşları 27 ile 89 arasında değişmekte olup, ortalama yaş 56,27±13,87 yıl olarak saptandı. İki grup arasında tedavi öncesi ve 48. saatte bakılan; beyaz küre (Wbc), lenfosit, nötrofil, ferritin, C Reaktif Protein (CRP), prokalsitonin, fibrinojen, D-dimer, kreatinin değerleri benzerdi (p> 0,05). Anakinra tedavisi alan 42 hastanın 21’i (% 50) exitus oldu, 21’i (% 50) servise alındı. Tosilizumab tedavisi alan 27 hastanın 23’ü (% 85,2) exitus oldu, 4’ü (% 14,8) servise alındı. Anakinra ve tosilizumab arasında mortalite açısından anlamlı fark olduğu tespit edildi (p= 0,014). Sonuç: Çalışmamızda COVID-19 nedenli SF gelişen hastalarda anakinra tedavisi, tosilizumaba göre mortalite açısından üstün bulunmuştur.

Anahtar Kelimeler:

Covid-19, Sitokin Fırtınası, Anakinra, Tosilizumab

Comparison of Anakinra and Tocilizumab Treatments in Cytokine Storm Due to COVID-19

Aim: It is thought that cytokine storm (CS) developing due to Coronavirus-19 disease (COVID-19) is important in affecting mortality and morbidity. In our study, it was aimed to compare the efficacy of tocilizumab and anakinra in patients hospitalized with CS in the intensive care clinic. Material and Methods: Between January 2021 and December 2021, 69 patients who were developed CS were included in the study. Treatment durations and doses who received anakinra or tocilizumab treatment, and previous treatments (favipiravir and pulse steroids) were recorded. Biochemical parameters of the patients were retrospectively analyzed. Results: Of the cases with CS, 42 (60.9%) received anakinra and 27 (39.1%) tocilizumab. Of the cases, 39.1% (n=27) were female and 60.9% (n=42) were male. The ages of the cases ranged from 27 to 89 years, and the mean age was 56.27±13.87 years. Between the two groups, before treatment and at the 48th hour; white blood cell (Wbc), lymphocyte, neutrophil, ferritin, C Reactive Protein (CRP), procalcitonin, fibrinogen, D-dimer, creatinine values were similar (p> 0.05). Of the 42 patients who received anakinra treatment, 21 (50%) died, and 21 (50%) were taken to the ward. Of 27 patients who received tocilizumab treatment, 23 (85.2%) died, and 4 (14.8%) were taken to the ward. There was a significant difference in mortality between anakinra and tocilizumab (p= 0.014). Conclusion: In our study, anakinra treatment was found to be superior to tocilizumab in terms of mortality in patients who developed CS.

Keywords:

Covid-19, Cytokine Storm, Anakinra, Tosilizumab,

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