Farrokhpour Mohsen, Rezaie Nader, Moradi Najmeh, Ghaffari Rad Fatemeh, Izadi Shirin, Azimi Mehdi, Zamani Farhad, Izadi Shahrokh, Ranjbar Mitra, Jamshidi Makiani Mahin, Laali Azadeh, Roham Maryam, Yadollahzadeh Mahdi
Department of Internal Medicine, Firoozgar Medical and Educational Hospital, Iran University of Medical Sciences, Tehran, Iran.
Gastrointestinal and liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2021 Feb 1;24(2):139-143. doi: 10.34172/aim.2021.22.
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).
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).
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; ( = 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 < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, = 0.071).
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.
2019年冠状病毒病（COVID-19）重症患者可能会引发细胞因子风暴综合征，进而导致急性呼吸衰竭综合征甚至死亡。我们的目的是研究英夫利昔单抗、静脉注射免疫球蛋白（IVIg）或联合治疗对入住重症监护病房（ICU）的COVID-19重症患者的治疗效果。
在这项观察性研究中，我们研究了2020年3月在伊朗德黑兰一家多专科医院ICU收治的104例插管成年COVID-19重症感染患者（基于临床症状以及影像学或CT扫描参数）。所有病例均接受当地方案的标准治疗方案（奥司他韦+羟氯喹+洛匹那韦/利托那韦或索磷布韦或阿扎那韦±利巴韦林）。病例分为对照组（n = 43）、英夫利昔单抗组（n = 27）、IVIg组（n = 23）和联合治疗组（n = 11）。
对照组和治疗组在基础疾病或基础疾病数量方面无显著差异。对照组病例的平均年龄（标准差）为72.42（16.06），IVIg组为64.52（12.965），英夫利昔单抗组为63.40（17.57），联合治疗组为64.00（11.679）；（分别为 = 0.047、0.031和0.11）。此外，英夫利昔单抗组37%、IVIg组26.1%、联合治疗组45.5%、对照组62.8%的患者死亡（均 < 0.05）。风险比IVIg组为0.31（95%置信区间：0.12 - 0.76， = 0.01），英夫利昔单抗组为0.30（95%置信区间：0.13 - 0.67， = 0.004），联合治疗组为0.39（95%置信区间：0.12 - 1.09， = 0.071）。
根据本研究结果，对于COVID-19重症患者，英夫利昔单抗和IVIg单独或联合使用似乎可被视为有效的治疗方法。
