Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial
Introduction: Severe lung injury is triggered by both the SARS-CoV-2 infection and the subsequent host-immune response in some COVID-19 patients. Methods: We conducted a randomized, single-center, open-label, phase II trial with the aim to evaluate the efficacy and safety of methylprednisolone pulse...
| Autores: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2021 |
| País: | España |
| Institución: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositorio: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:20.500.12328/2692 |
| Acceso en línea: | http://hdl.handle.net/20.500.12328/2692 https://dx.doi.org/10.3389/fmed.2021.691712 |
| Access Level: | acceso abierto |
| Palabra clave: | COVID-19 (malaltia) SARS-CoV-2 Metilprednisolona Tacrolimus Inflamació Lesió pulmonar COVID-19 Inflamación Lesión pulmonar Methylprednisolone Inflammation Lung injury 61 |
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| dc.title.none.fl_str_mv |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| title |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| spellingShingle |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial Solanich, Xavier COVID-19 (malaltia) SARS-CoV-2 Metilprednisolona Tacrolimus Inflamació Lesió pulmonar COVID-19 SARS-CoV-2 Metilprednisolona Tacrolimus Inflamación Lesión pulmonar COVID-19 SARS-CoV-2 Methylprednisolone Tacrolimus Inflammation Lung injury 61 |
| title_short |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| title_full |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| title_fullStr |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| title_full_unstemmed |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| title_sort |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trial |
| dc.creator.none.fl_str_mv |
Solanich, Xavier Antolí, Arnau Rocamora-Blanch, Gemma Padullés, Núria Fanlo-Maresma, Marta Iriarte, Adriana Mitjavila, Francesca Capdevila, Olga Riera-Mestre, Antoni Bas, Jordi Vicens-Zygmunt, Vanesa Niubó, Jordi Calvo, Nahum Bolivar, Santiago Rigo-Bonnin, Raúl Mensa-Vilaró, Anna Arregui, Laura Tebé, Cristian Videla, Sebastià Hereu, Pilar Corbella Virós, Xavier |
| author |
Solanich, Xavier |
| author_facet |
Solanich, Xavier Antolí, Arnau Rocamora-Blanch, Gemma Padullés, Núria Fanlo-Maresma, Marta Iriarte, Adriana Mitjavila, Francesca Capdevila, Olga Riera-Mestre, Antoni Bas, Jordi Vicens-Zygmunt, Vanesa Niubó, Jordi Calvo, Nahum Bolivar, Santiago Rigo-Bonnin, Raúl Mensa-Vilaró, Anna Arregui, Laura Tebé, Cristian Videla, Sebastià Hereu, Pilar Corbella Virós, Xavier |
| author_role |
author |
| author2 |
Antolí, Arnau Rocamora-Blanch, Gemma Padullés, Núria Fanlo-Maresma, Marta Iriarte, Adriana Mitjavila, Francesca Capdevila, Olga Riera-Mestre, Antoni Bas, Jordi Vicens-Zygmunt, Vanesa Niubó, Jordi Calvo, Nahum Bolivar, Santiago Rigo-Bonnin, Raúl Mensa-Vilaró, Anna Arregui, Laura Tebé, Cristian Videla, Sebastià Hereu, Pilar Corbella Virós, Xavier |
| author2_role |
author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
COVID-19 (malaltia) SARS-CoV-2 Metilprednisolona Tacrolimus Inflamació Lesió pulmonar COVID-19 SARS-CoV-2 Metilprednisolona Tacrolimus Inflamación Lesión pulmonar COVID-19 SARS-CoV-2 Methylprednisolone Tacrolimus Inflammation Lung injury 61 |
| topic |
COVID-19 (malaltia) SARS-CoV-2 Metilprednisolona Tacrolimus Inflamació Lesió pulmonar COVID-19 SARS-CoV-2 Metilprednisolona Tacrolimus Inflamación Lesión pulmonar COVID-19 SARS-CoV-2 Methylprednisolone Tacrolimus Inflammation Lung injury 61 |
| description |
Introduction: Severe lung injury is triggered by both the SARS-CoV-2 infection and the subsequent host-immune response in some COVID-19 patients. Methods: We conducted a randomized, single-center, open-label, phase II trial with the aim to evaluate the efficacy and safety of methylprednisolone pulses and tacrolimus plus standard of care (SoC) vs. SoC alone, in hospitalized patients with severe COVID-19. The primary outcome was time to clinical stability within 56 days after randomization. Results: From April 1 to May 2, 2020, 55 patients were prospectively included for subsequent randomization; 27 were assigned to the experimental group and 28 to the control group. The experimental treatment was not associated with a difference in time to clinical stability (hazard ratio 0.73 [95% CI 0.39–1.37]) nor most secondary outcomes. Median methylprednisolone cumulative doses were significantly lower (360 mg [IQR 360–842] vs. 870 mg [IQR 364–1451]; p = 0.007), and administered for a shorter time (median of 4.00 days [3.00–17.5] vs. 18.5 days [3.00–53.2]; p = 0.011) in the experimental group than in the control group. Although not statistically significant, those receiving the experimental therapy showed a numerically lower all-cause mortality than those receiving SoC, especially at day 10 [2 (7.41%) vs. 5 (17.9%); OR 0.39 (95% CI 0.05–2.1); p = 0.282]. The total number of non-serious adverse events was 42 in each the two groups. Those receiving experimental treatment had a numerically higher rate of non-serious infectious adverse events [16 (38%) vs. 10 (24%)] and serious infectious adverse events [7 (35%) vs. 3 (23%)] than those receiving SoC. Conclusions: The combined use of methylprednisolone pulses plus tacrolimus, in addition to the SoC, did not significantly improve the time to clinical stability or other secondary outcomes compared with the SoC alone in severe COVID-19. Although not statistically significant, patients receiving the experimental therapy had numerically lower all-cause mortality than those receiving SoC, supporting recent non-randomized studies with calcineurin inhibitors. It is noteworthy that the present trial had a limited sample size and several other limitations. Therefore, further RCTs should be done to assess the efficacy and safety of tacrolimus to tackle the inflammatory stages of COVID-19. |
| publishDate |
2021 |
| dc.date.none.fl_str_mv |
2021 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/20.500.12328/2692 https://dx.doi.org/10.3389/fmed.2021.691712 |
| url |
http://hdl.handle.net/20.500.12328/2692 https://dx.doi.org/10.3389/fmed.2021.691712 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Frontiers in Medicine 8; |
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https://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
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https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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11 |
| dc.publisher.none.fl_str_mv |
Frontiers Media |
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Frontiers Media |
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reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Recercat. Dipósit de la Recerca de Catalunya |
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Recercat. Dipósit de la Recerca de Catalunya |
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1869409241432850432 |
| spelling |
Methylprednisolone pulses plus tacrolimus in addition to standard of care vs. standard of care alone in patients with severe COVID-19. A randomized controlled trialSolanich, XavierAntolí, ArnauRocamora-Blanch, GemmaPadullés, NúriaFanlo-Maresma, MartaIriarte, AdrianaMitjavila, FrancescaCapdevila, OlgaRiera-Mestre, AntoniBas, JordiVicens-Zygmunt, VanesaNiubó, JordiCalvo, NahumBolivar, SantiagoRigo-Bonnin, RaúlMensa-Vilaró, AnnaArregui, LauraTebé, CristianVidela, SebastiàHereu, PilarCorbella Virós, XavierCOVID-19 (malaltia)SARS-CoV-2MetilprednisolonaTacrolimusInflamacióLesió pulmonarCOVID-19SARS-CoV-2MetilprednisolonaTacrolimusInflamaciónLesión pulmonarCOVID-19SARS-CoV-2MethylprednisoloneTacrolimusInflammationLung injury61Introduction: Severe lung injury is triggered by both the SARS-CoV-2 infection and the subsequent host-immune response in some COVID-19 patients. Methods: We conducted a randomized, single-center, open-label, phase II trial with the aim to evaluate the efficacy and safety of methylprednisolone pulses and tacrolimus plus standard of care (SoC) vs. SoC alone, in hospitalized patients with severe COVID-19. The primary outcome was time to clinical stability within 56 days after randomization. Results: From April 1 to May 2, 2020, 55 patients were prospectively included for subsequent randomization; 27 were assigned to the experimental group and 28 to the control group. The experimental treatment was not associated with a difference in time to clinical stability (hazard ratio 0.73 [95% CI 0.39–1.37]) nor most secondary outcomes. Median methylprednisolone cumulative doses were significantly lower (360 mg [IQR 360–842] vs. 870 mg [IQR 364–1451]; p = 0.007), and administered for a shorter time (median of 4.00 days [3.00–17.5] vs. 18.5 days [3.00–53.2]; p = 0.011) in the experimental group than in the control group. Although not statistically significant, those receiving the experimental therapy showed a numerically lower all-cause mortality than those receiving SoC, especially at day 10 [2 (7.41%) vs. 5 (17.9%); OR 0.39 (95% CI 0.05–2.1); p = 0.282]. The total number of non-serious adverse events was 42 in each the two groups. Those receiving experimental treatment had a numerically higher rate of non-serious infectious adverse events [16 (38%) vs. 10 (24%)] and serious infectious adverse events [7 (35%) vs. 3 (23%)] than those receiving SoC. Conclusions: The combined use of methylprednisolone pulses plus tacrolimus, in addition to the SoC, did not significantly improve the time to clinical stability or other secondary outcomes compared with the SoC alone in severe COVID-19. Although not statistically significant, patients receiving the experimental therapy had numerically lower all-cause mortality than those receiving SoC, supporting recent non-randomized studies with calcineurin inhibitors. It is noteworthy that the present trial had a limited sample size and several other limitations. Therefore, further RCTs should be done to assess the efficacy and safety of tacrolimus to tackle the inflammatory stages of COVID-19.info:eu-repo/semantics/publishedVersionFrontiers Media2021info:eu-repo/semantics/article11http://hdl.handle.net/20.500.12328/2692https://dx.doi.org/10.3389/fmed.2021.691712reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésFrontiers in Medicine8;© 2021 Solanich, Antolí, Rocamora-Blanch, Padullés, Fanlo-Maresma, Iriarte, Mitjavila, Capdevila, Riera-Mestre, Bas, Vicens-Zygmunt, Niubó, Calvo, Bolivar, Rigo-Bonnin, Mensa-Vilaró, Arregui, Tebe, Videla, Hereu and Corbella. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:20.500.12328/26922026-05-29T05:05:01Z |
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15,81155 |