Новости | Магазин | Журналы | Контакты | Правила | Доставка | |
Вход Регистрация |
Цель исследования: обзор и анализ имеющейся зарубежной литературы, посвященной КТ-семиотике COVID-19-пневмонии у пациентов, получающих в качестве патогенетической терапии тоцилизумаб. Материал и методы. Проанализировано 6 публикаций, которые были доступны по ключевым словам “COVID-19”, “radiology”, “CT”, “tocilizumab”, “сytokine release syndrome”, “interleukin 6”, “IL-6”. Поиск ограничивался только рукописями на английском языке без ограничения по времени. Последний раз поиск литературы проводился 3 июня 2020 г. Результаты. На сегодняшний день существует небольшое количество исследований, посвященных КТ-семиотике COVID-19-пневмонии при лечении актемрой (тоцилизумабом). По запросу “COVID-19”, “radiology”, “CT”, “tocilizumab”, “сytokine release syndrome”, “interleukin 6”, “IL-6” в базе данных медицинских и биологических публикаций “PubMed” на 03.06.2020 можно найти только 8 публикаций, которые удовлетворяли бы поисковому запросу, из них только 1 полнотекстовая статья, целью которой было исследование КТ-семиотики COVID-19-пневмонии у пациентов, получающих в качестве терапии тоцилизумаб. Важно отметить, что новые данные распространяются регулярно, и до сих пор они состоят в основном из препринтов, кейсов, отчетов, небольших клинических случаев. Заключение. Проанализировав имеющуюся литературу, можно сделать вывод, что подавляющее число авторов подтверждают положительный эффект, связанный с приемом тоцилизумаба, о чем свидетельствует очень быстрое улучшение состояния больных. Однако КТ-картина часто не коррелирует с клиническим течением заболевания и не всегда демонстрирует улучшение по картине легких, что должно расцениваться не как отрицательная динамика, а как естественный регресс патологических изменений легочной ткани, который может занимать некоторое количество времени.
Ключевые слова:
COVID-19, тоцилизумаб, КТ, ИЛ-6 Авторы подтверждают отсутствие конфликтов интересов, COVID-19, CT, tocilizumab, IL-6
Литература:
1.Fu L., Wang B., Yuan T., Chen X., Ao Y., Fitzpatrick T., Li P., Zhou Y., Lin Y.F., Duan Q., Luo G., Fan S., Lu Y., Feng A., Zhan Y., Liang B., Cai W., Zhang L., Du X., Li L., Shu Y., Zou H. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and metaanalysis. J. Infect. 2020; 80 (6): 656-665. https://doi.org/10.1016/j.jinf.2020.03.041.
2.WHO main website. http://www.euro.who.int/ru/healthtopics/health-emergencies/coronavirus-covid-19 (accessed March 12, 2020)
3.Лучевая диагностика коронавирусной болезни (COVID-19): организация, методология, интерпретация результатов. Препринт № ЦДТ - 2020 - II Версия 2 (17.04.2020). Текст: электронный.
4.Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19 [published online ahead of print, 2020 Mar 28]. Int. J. Antimicrob. Agents. 2020. https://doi.org/10.1016/j.ijantimicag.2020.105955
5.Временные методические рекомендации профилактики, диагностики и лечения новой коронавирусной инфекции (COVID-19) Минздрава РФ. Версия 6 от 28.04.2020.
6.Li Y., Xia L. Coronavirus Disease 2019 (COVID-19): role of chest CT in diagnosis and management. Am. J. Roentgenol. 2020; 214 (6): 1280-1286. https://doi.org/10.2214/AJR.20.22954
7.https://www.rosminzdrav.ru/ministry/med_covid19 Recommendations for doctors on Covid-19 of the Ministry of Health of the Russian Federation.
8.Chen J. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19. 2020; 10 (Google Scholar)
9.Li Y., Xie Z., Lin W., Cai W., Wen C. et al. An exploratory randomized controlled study on the efficacy and safety of lopinavir/ritonavir or arbidol treating adult patients hospitalized with mild/moderate COVID-19 (ELACOI). [online]. Website https://www.medrxiv.org/ content/10.1101/2020.03.19.20038984v2 [accessed 12 April 2020].
10.Young B.E., Ong S.W.X., Kalimuddin S., Low J.G., Tan S.Y. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020; 10 [PMC free article] [PubMed] [Google Scholar]
11.Chen C.Y., Wang F.L., Lin C.C. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin. Toxicology. 2006; 44: 173-175. https://doi.org/10.1080/15563650500514558
12.Borba M.G.S., De Almeida Val F., Sampaio V.S., Araujo Alexandre M.A., Melo G.C. et al. Chloroquine diphosphate in two different dosages as adjunctive therapy ofhospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: preliminary safety results of a randomized, doubleblinded, phase IIb clinical trial (CloroCovid-19 Study) [online]. (2020). https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v2 [accessed 12 April 2020]
13.Chorin E., Dai M., Shulman E., Wadhwani L., Cohen R.B. et al. The QT interval in patients with SARS-CoV-2 infection treated with hydroxychloroquine/azithromycin [online]. 2020. https://www.medrxiv.org/content/10.1101/2020.04.02.20047050v1 [accessed 12 April 2020].
14.Mehra M.R., Desai S.S., Ruschitzka F., Patel A.N. RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 May 22: S0140-6736(20)31180-6. https://doi.org/10.1016/S0140-6736(20)31180-6. Epub ahead of print. Erratum in: Lancet. 2020 May 30: PMID: 32450107; PMCID: PMC7255293.
15.Ministry of Health of the Russian Federation “On the use of the drug Hydroxychloroquine for the treatment of patients with coronavirus infection” dated May 28, 2020. https://www.rosminzdrav.ru/news/2020/05/28/14067-oprimenenii-preparata-gidroksihlorohin-dlya-lecheniyapatsientov-s-koronavirusnoy-infektsiey
16.Chu C.M., Cheng V.C., Hung I.F.N., Wong M.M., Chan K.H. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004; 59: 252-256. https://doi.org/10.1136/thorax.2003.012658
17.Ye X.T., Luo Y.L., Xia S.C., Sun Q.F., Ding J.G., Zhou Y., Chen W., Wang X.F., Zhang W.W., Du W.J., Ruan Z.W., Hong L. Clinical efficacy of lopinavir/ritonavir in the treatment of Coronavirus disease 2019. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (6): 3390-3396.htt ps://doi.org/10.26355/eurrev_202003_20706. PMID: 32271456.
18.Assessment Report For RoActemra [Internet] 1st ed. London: European Medicines Agency; 2009. [accessed 2017 January 3]. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000955/WC500054888.pdf
19.https://www.roche.ru/content/dam/rochexx/roche-ru/roche_russia/ru_RU/Instructions/actemraiv-2019-12-30.pdf Версия 10 МИНЗДРАВ РОССИИ ЛСР-003012/09-301219
20.Higuchi T., Nakanishi T., Takada K., Matsumoto M., Okada M., Horikoshi H., Suzuki K. A case of multicentric castleman''s disease having lung lesion successfully treated with humanized anti-interleukin-6 receptor antibody, Tocilizumab. J. Korean Med. Sci. 2010; 25 (9): 1364-1367. https://doi.org/10.3346/jkms.2010.25.9.1364. PMID:20808682.
21.FDA approves tisagenlecleucel for B-cell ALL and tocilizumab for cytokine release syndrome. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-tisagenlecleucel-b-cell-all-andtocilizumab-cytokine-release-syndrome
22.Moore J.B., June C.H. Cytokine release syndrome in severe COVID-19. Science. 2020; 368 (6490): 473-474. https://doi.org/10.1126/science.abb8925
23.Le R.Q., Li L., Yuan W., Shord S.S., Nie L., Habtemariam B.A., Przepiorka D., Farrell A.T., Pazdurb R. Tocilizumab for Treatment of Chimeric Antigen Receptor T Cell-Induced Severe or Life-Threatening Cytokine Release Syndrome. Oncologist. 2018; 23 (8): 943-947. https://doi.org/10.1634/theoncologist.2018-0028
24.Yuan J., Zou R., Zeng L. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients. Inflamm. Res. 2020 Mar 29: 1-8. https://doi.org/10.1007/s00011-020-01342-0
25.Zhang C., Wu Z., Li J.W., Zhao H., Wang G.Q. The cytokine release syndrome (CRS) of severe COVID-19 and Inter leukin-6 receptor (IL-6R) antagonist tocilizumab may be the key to reduce the mortality. Int. J. Antimicrob. Agents. 2020:105954. https://doi.org/10.1016/j.ijantimicag.2020.105954.
26.Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of 2019 novel coronavirus infection in China. Med. Rxiv. 2019;2020:2020. https://doi.org/10.1101/2020.02.06.20020974
27.https://www.rosminzdrav.ru/ministry/med_covid19
28.Cellina M, Orsi M, Bombaci F, Sala M, Marino P, Oliva G. Favorable changes of CT findings in a patient with COVID-19 pneumonia after treatment with tocilizumab. Diagn. Interv. Imaging. 2020; 101 (5): 323-324. https://doi.org/10.1016/j.diii.2020.03.010.
29.Xu X., Han M., Li T., Sun W., Wang D., Fu B., Zhou Y., Zheng X., Yang Y., Li X., Zhang X., Pan A., Wei H. Effective Treatment of Severe COVID-19 Patients With Tocilizumab. Proc. Natl. Acad. Sci. USA. 2020; 117 (20): 10970-10975. https://doi.org/10.1073/pnas.2005615117
30.Michot J.-M., Albiges L., Chaput N., Saada V., Pommeret F., Griscelli F., Balleyguier C., Besse B., Marabelle A., Netzer F., Merad M., Robert C., Barlesi F., Gachot B., Stoclin A. Tocilizumab, an anti-IL-6 receptor antibody, to treat COVID-19-related respiratory failure: a case report. Ann. Oncol. 2020 Apr 2: S0923-7534(20)36387-0. https://doi.org/10.1016/j.annonc.2020.03.300
31.Wang L., Peng X., Wang Z.-H., Cai J., Zhou F.-C. Tocilizumab in the treatment of a critical COVID-19 patient: a case report. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (10): 5783-5787. https://doi.org/10.26355/eurrev_202005_21372
32.Mihai C., Dobrota R., Schroder M., Garaiman A., Jordan S., Becker M.O., Maurer B., Distler O. COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD. Ann. Rheum. Dis. 2020; 79 (5): 668-669. https://doi.org/10.1136/annrheumdis-2020-217442
33.The first affiliated hospital of university of science and technology. The efficacy and safety of tocilizumab in the treatment of novel coronavirus pneumonia: a multi-center, randomized, double-blinded trial. 2020. https://www.chictr.org.cn/showproj. aspx?proj=49409. Accessed 22 Feb 2020.
Purpose. Review and analysis of the available foreign literature about CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab. Material and methods. 6 publications were analyzed that were available for the keywords “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6”. Search was limited only to English language manuscripts with no time limit. The literature search was last done on 3rd June 2020. Results. There is a small number of studies on CT findings of COVID-19 pneumonia during the treatment of actemra (tocilizumab). At the request of “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6” in the database of medical and biological publications “PubMed” on 03.06.2020 can be found only 8 publications that would satisfy the search query. At the time of writing this article we were able to locate only 1 full text articles in English which was the study of CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab. It is important to note that new data is being shared regularly and so far, it consists mostly of pre-prints, case reports, small case series. Conclusion. After analyzing the available literature, it can be concluded that the majority of authors confirm the positive effect associated with taking tocilizumab, as evidenced by a very rapid improvement in the condition of patients, however, the CT-findings often does not correlate with the clinical course of the disease and does not always show improvement in lung tissue, which should not be regarded as negative dynamics, but as a natural regression of pathological changes in lung tissue.
Keywords:
COVID-19, тоцилизумаб, КТ, ИЛ-6 Авторы подтверждают отсутствие конфликтов интересов, COVID-19, CT, tocilizumab, IL-6