PMID- 35238257
OWN - NLM
STAT- MEDLINE
DCOM- 20220308
LR  - 20221207
IS  - 1365-2060 (Electronic)
IS  - 0785-3890 (Print)
IS  - 0785-3890 (Linking)
VI  - 54
IP  - 1
DP  - 2022 Dec
TI  - Therapeutic safety and efficacy of triple-immunosuppressants versus 
      dual-immunosuppressants in severe-to-critical COVID-19: a prospective cohort 
      study in Bangladesh.
PG  - 723-732
LID - 10.1080/07853890.2022.2039958 [doi]
AB  - BACKGROUND: Hyperinflammation-induced respiratory failure is a leading cause of 
      mortality in COVID-19 infection. Immunosuppressants such as, Baricitinib and 
      interleukin inhibitors are the drug-of-choice to suppress cytokine storm in 
      COVID-19. Here, we compared the therapeutic safety and efficacy of 
      triple-immunosuppressants with dual-immunosuppressants in patients with 
      severe-to-critical COVID-19. METHODS: This study was conducted on 103 confirmed 
      COVID-19 patients. Of 103 patients, 49 (N) and 54 (N) patients received 
      dual-immunosuppressants (baricitinib plus two doses of secukinumab) and triple 
      immunosuppressants (baricitinib plus single dose of tocilizumab and secukinumab) 
      in group A and group B, respectively. Groups were compared in terms of clinical 
      outcome, critical support-requirement, survival, re-hospitalisation, and adverse 
      events (AEs). RESULTS: Patients in group B achieved normal blood oxygen 
      saturation level (SpO(2)) earlier than the patients of group A [4 day (IQR: 3-12) 
      vs 5 day (IQR: 5-14), p < .05]. The requirement of intensive care unit (ICU) and 
      mechanical ventilation (MV) support was less in group B than group A 
      [16.7%/28.6%, 11.1%/18.4%, respectively p < .05]]. The incidence of COVID-19 
      acute respiratory distress syndrome and 60-day all cause mortality was reduced in 
      group B compared to group A [0.43 (0.19-0.98), p < .05; 0.35 (0.08-1.44), 
      p > .05]. The 60-day re-hospitalisation rate was two-fold high in group A than 
      group B (p = .024). Immunosuppressant-associated adverse events and secondary 
      bacterial/fungal infections were relative high in patients of group B. 
      CONCLUSIONS: Triple-immunosuppressants in severe-to-critical COVID-19 infection 
      exhibited better clinical outcome; reduced ICU and MV requirement; shorter 
      hospital stay with deceased 60-day all cause mortality and re-hospitalisation 
      compared to dual-immunosuppressants.
FAU - Hasan, Md Jahidul
AU  - Hasan MJ
AUID- ORCID: 0000-0001-7038-6437
AD  - Clinical Pharmacist (Critical Care and Infectious Diseases/Stewardship), 
      Coordinator-Clinical Pharmacy, Department of Pharmacy, Square Hospitals Ltd, West 
      Panthapath, Bangladesh.
FAU - Rabbani, Raihan
AU  - Rabbani R
AUID- ORCID: 0000-0001-5173-5793
AD  - Internal Medicine and Intensive Care Unit, Department of Medical Services, Square 
      Hospitals Ltd, West Panthapath, Bangladesh.
FAU - Anam, Ahmad Mursel
AU  - Anam AM
AUID- ORCID: 0000-0001-9673-9704
AD  - High Dependency Unit (HDU), Department of Medical Services, Square Hospitals Ltd, 
      West Panthapath, Bangladesh.
FAU - Huq, Shihan Mahmud Redwanul
AU  - Huq SMR
AD  - Internal Medicine and Intensive Care Unit, Department of Medical Services, Square 
      Hospitals Ltd, West Panthapath, Bangladesh.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Ann Med
JT  - Annals of medicine
JID - 8906388
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Bangladesh
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects
MH  - Prospective Studies
MH  - SARS-CoV-2
MH  - Treatment Outcome
MH  - *COVID-19 Drug Treatment
PMC - PMC8903771
OTO - NOTNLM
OT  - COVID-19
OT  - baricitinib
OT  - cytokine storm
OT  - immunosuppressant
OT  - secukinumab
OT  - tocilizumab
COIS- No potential conflict of interest was reported by the authors.
EDAT- 2022/03/04 06:00
MHDA- 2022/03/09 06:00
PMCR- 2022/03/03
CRDT- 2022/03/03 08:46
PHST- 2022/03/03 08:46 [entrez]
PHST- 2022/03/04 06:00 [pubmed]
PHST- 2022/03/09 06:00 [medline]
PHST- 2022/03/03 00:00 [pmc-release]
AID - 2039958 [pii]
AID - 10.1080/07853890.2022.2039958 [doi]
PST - ppublish
SO  - Ann Med. 2022 Dec;54(1):723-732. doi: 10.1080/07853890.2022.2039958.