scholarly journals The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1280
Author(s):  
Shinta Oktya Wardhani ◽  
Jonny Karunia Fajar ◽  
Gatot Soegiarto ◽  
Laksmi Wulandari ◽  
Helnida Anggun Maliga ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Critically Ill ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Therapeutic Plasma Exchange ◽  
Cytokine Storm ◽  
Science Data ◽  
Risk Of Mortality ◽  
Potential Benefits ◽  
Reduction Of Mortality

Background: Cytokine storm has been widely known to contribute to the development of the critical condition in patients with coronavirus disease 2019 (COVID-19), and studies had been conducted to assess the potential aspect of cytokine storm elimination by performing therapeutic plasma exchange (TPE). However, contradictory findings were observed. The objective of this study was to assess the association between TPE and the reduction of mortality of critically ill COVID-19 patients. Methods: A meta-analysis was conducted by collecting data from PubMed, Scopus, and Web of Science. Data on the mortality rate of critically ill COVID-19 patients treated with TPE plus standard of care and that of patients treated with standard of care alone were analyzed using a Z test. Results: We included a total of four papers assessing the association between TPE and the risk of mortality among critically ill COVID-19 patients. Our findings suggested that critically ill COVID-19 patients treated with TPE had lower risk of mortality compared to those without TPE treatment. Conclusion: Our study has identified the potential benefits of TPE in reducing the risk of mortality among critically ill COVID-19 patients.

scholarly journals Therapeutic Plasma Exchange: A potential Management Strategy for Critically Ill COVID-19 Patients

2020 ◽  
Vol 35 (9) ◽  
pp. 827-835 ◽  
Author(s):  
Seena Tabibi ◽  
Tara Tabibi ◽  
Rosalynn R. Z. Conic ◽  
Nassim Banisaeed ◽  
Michael B. Streiff
Keyword(s):  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Laboratory Data ◽  
Therapeutic Plasma Exchange ◽  
Medical Treatments ◽  
Clinical Observations ◽  
Cytokine Levels ◽  
Potential Benefits ◽  
Trial Phase

In the 5 months since initial reports of COVID-19 came to light, the death toll due to SARS-CoV-2 has rapidly increased. The morbidity and mortality of the infection varies based upon patient age, comorbid conditions, viral load, and the availability of effective treatments. Findings from limited autopsies, clinical observations, and laboratory data suggest that high cytokine levels and a procoagulant state can precipitate acute respiratory distress syndrome and multi-organ dysfunction syndrome in critically ill patients. To complicate matters, comorbidities may affect the response to medical treatments currently in use, all of which are still in trial phase. Therapeutic plasma exchange (TPE) merits consideration in the treatment of critically ill COVID-19 patients and is an avenue for clinical trials to pursue. If efficacious, faster recovery of patients may lead to shorter intensive care unit stays and less time on mechanical ventilation. Herein, we briefly discuss some of the various approaches currently being investigated for the treatment of SARS-CoV-2 with a focus on potential benefits of TPE for selected critically ill patients.

scholarly journals Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

2020 ◽  
Vol 60 ◽  
pp. 328-333 ◽  
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Mohammed Alodat ◽  
Demetrios J. Kutsogiannis ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

scholarly journals Therapeutic Plasma Exchange Using Convalescent Plasma Replacement Therapy in Severe COVID-19 Infections: A Potential Therapeutic Option

2021 ◽  
pp. 78-81
Author(s):  
Joy Varghese ◽  
Pushkala Subramanian ◽  
Venkataraman Jayanthi
Keyword(s):  
Public Health ◽  
Plasma Exchange ◽  
Inflammatory Markers ◽  
Therapeutic Option ◽  
Public Health Emergency ◽  
Therapeutic Plasma Exchange ◽  
Cytokine Storm ◽  
Global Public Health ◽  
Plasma Therapy ◽  
Key Factor

Currently, the coronavirus disease (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), is a major global public health emergency. Cytokine storm is a key factor and plays a major role in disease severity and clinical outcome. Recently, the literature reveals the use of therapeutic plasma exchange to reduce the inflammatory markers. Evidence also exists for the use of convalescent plasma therapy in patients with severe COVID-19. This brief communication explores the advantages on therapeutic plasma exchange with convalescent plasma in patients with moderate-to-severe COVID-19.

scholarly journals Efficacy and safety of tocilizumab in the management of COVID-19: A systematic review and meta-analysis of observational studies

2021 ◽  
Author(s):  
Gollapalle L Viswanatha ◽  
CH K V L S N Anjana Male ◽  
Hanumanthappa Shylaja
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Efficacy And Safety ◽  
Risk Of Mortality ◽  
Significant Difference ◽  
Newcastle Ottawa Scale ◽  
Soc Control ◽  
Ottawa Scale

AbstractBackgroundThis systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19).MethodsThe electronic search was performed using PubMed, Scopus, CENTRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th September 2020. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/placebo. Inconsistency between the studies was evaluated with I2 and quality of the evidences were evaluated by Newcastle-Ottawa scale.ResultsBased on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced the mortality (M-H,RE-OR −0.11(−0.18 to −0.04) 95% CI, p =0.001, I2 =88%) and increased the incidences of super-infections (M-H, RE-OR 1.49(1.13 to 1.96) 95% CI, p=0.004, I2=47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR −0.06(−0.23 to 0.12), I2=93%), need of MV (M-H, RE-OR of 0.00(−0.06 to 0.07), I = 74%), LOS (IV −2.86(−0.91 to 3.38), I2=100%), LOS-ICU (IV: −3.93(−12.35 to 4.48), I2=100%), and incidences of pulmonary thrombosis (M-H, RE-OR 1.01 (0.45 to 2.26), I2=0%) compared to SOC/control.ConclusionBased on cumulative low to moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalized patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters.

scholarly journals Does therapeutic plasma exchange have a role in resistant cytokine storm state of COVID-19 infection?

2021 ◽  
Vol 57 (1) ◽  
pp. 235-239
Author(s):  
Mohamed Mamdouh Elsayed ◽  
Montasser Mohamed Zeid ◽  
Akram Mohamed Fayed ◽  
Ehab Mahmoud Elreweny ◽  
Nermine Hossam Zakaria ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Cytokine Storm

scholarly journals Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 73
Author(s):  
Cahyo Wibisono Nugroho ◽  
Satriyo Dwi Suryantoro ◽  
Yuliasih Yuliasih ◽  
Alfian Nur Rosyid ◽  
Tri Pudy Asmarawati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Eligibility Criteria ◽  
All Cause Mortality ◽  
Clinical Benefits

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.

scholarly journals Efficacy of Tocilizumab in Covid 19: A metanalysis of case series studies

2020 ◽  
Author(s):  
shalam Mohamed hussain ◽  
Syeda Ayesha Farhana ◽  
Osama Alwutayd ◽  
Abdullah Alnafeesah ◽  
Mohammad Alshammari ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Case Series ◽  
Standard Of Care ◽  
Current Status ◽  
Cytokine Storm ◽  
Data Synthesis ◽  
Quantitative Synthesis ◽  
Study Designs

Abstract Background : characteristic feature of COVID-19 during its progression in severity is the cytokine storm (via interleukin-6, IL-6) which is responsible for secondary acute respiratory distress syndrome (ARDS) [4]. Tocilizumab has an antagonist effect on the IL-6 receptor. With present review and metanalysis, we intend to update the current status on the clinical efficacy of tocilizumab in the treatment of Covid 19 infections in the published literature of case series. MATERIALS AND METHODS: The following inclusion criteria were used: (i) case series studies (number of reported patients in each study equal to or greater than ten (ii) use of tocilizumab alone or in combination with standard of care therapy (iii) Covid 19 adult patients (iv) the studies with endpoints on all-cause mortality, need for mechanical ventilation, clinical improvements. Data synthesis and statistical analysis Meta-analysis was performed using a random effects model and the DerSimonian and Laird method. RESULTS 18 were selected for the quantitative analysis (meta-analysis). 14 studies were retrospective and 4 were prospective Meta-analysis The mortality rate of COVID-19 patients with tocilizumab was 21% (251/1212) Asymmetric funnel plot in the cylindrical form due to publication bias In conclusion the present synthesis provide us useful insights with the other available evidence to refine our strategy and equip ourselves effectively with tocilizumab to defeat COVID 19 to save humanity. Limitations The included studies utilized varied doses of tocilizumab (single or double), and duration drug availability issues emerged in some centers, which may have influenced both sample sizes and study designs. Clinical implications: Incorporated studies without control groups into systematic reviews and quantitative synthesis especially when there are no other studies to consider can provide information for formulating effective treatment strategies for management of COVID 19 infections through the use of tocilizumab. Keywords: COVID 19; tocilizumab, interleukin-6, cytokine storm, case series

scholarly journals Early Tocilizumab Dosing is Associated with Improved Survival In Critically Ill Patients Infected With Sars-CoV-2

2020 ◽  
Author(s):  
Russell M. Petrak ◽  
Nicholas W. Van Hise ◽  
Nathan C. Skorodin ◽  
Robert M. Fliegelman ◽  
Vishnu Chundi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Standard Of Care ◽  
Control Group ◽  
Cytokine Storm ◽  
Novel Coronavirus ◽  
Multi Center Study ◽  
Center Study

AbstractBackgroundSARS-CoV-2 is a novel coronavirus that has rapidly expanded to become a pandemic, resulting in millions of deaths worldwide. The cytokine storm is caused by the release of inflammatory agents and results in a physiologic disruption. Tocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2.MethodsThis was a multi-center study of patients infected with SARS-CoV-2, admitted between 3/13/20 and 4/16/20, requiring mechanical ventilation. Parameters that were evaluated included age, sex, race, usage of steroids, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was utilized for comparison (untreated).FindingsWe studied 118 patients who required mechanical ventilation. Eighty-one (81) received tocilizumab, compared to 37 who were untreated. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p=0.003). Dosing tocilizumab late was associated with an increased mortality compared to the untreated group (p=0.006).InterpretationEarly tocilizumab administration was associated with decreased mortality in critically ill SARS-Co-V-2 patients, but a potential detriment was suggested by dosing later in a patient’s course.FundingThis work did not receive outside funding or sponsorship.

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