Author/Authors :
Farrokhpour, Mohsen Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Rezaie, Nader Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Moradi, Najmeh Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Ghaffari Rad, Fatemeh Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Izadi, Shirin Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Azimi, Mehdi Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Zamani, , Farhad Gastrointestinal and liver Diseases Research Center - Iran University of Medical Sciences, Tehran, Iran , Izadi, Shahrokh School of Public Health - Isfahan University of Medical Sciences, Isfahan, Iran , Ranjbar, Mitra Antimicrobial Resistance Research Center - Iran University of Medical Sciences, Tehran, Iran , Jamshidi Makiani, Mahin Antimicrobial Resistance Research Center - Iran University of Medical Sciences, Tehran, Iran , laali, Azadeh Department of Infectious Diseases - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran , Roham, Maryam Antimicrobial Resistance Research Center - Iran University of Medical Sciences, Tehran, Iran , Yadollahzadeh, Mahdi Yadollahzadeh Department of Internal Medicine - Firoozgar Medical and Educational Hospital - Iran University of Medical Sciences, Tehran, Iran
Abstract :
Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU).
Methods: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11).
Results: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071).
Conclusion: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.
