Author: Leelayuwatanakul, Nophol; Kongpolprom, Napplika; Sriprasart, Thitiwat; Phoophiboon, Vorakamol; Thanthitaweewat, Vorawut; Thawanaphong, Sarita; Sirichana, Worawan; Chirakalwasan, Naricha; Kawkitinarong, Kamon; Sittipunt, Chanchai; Putcharoen, Opass; Paitoonpong, Leilani; Suwanpimolkul, Gompol; Jantarabenjakul, Watsamon; Srisawat, Nattachai; Pachinburavan, Monvasi
Title: Multimodality treatment in immunocompromised patients with severe COVIDâ€19: the role of ILâ€6 inhibitor, intravenous immunoglobulin, and haemoperfusion Cord-id: er4ev0b0 Document date: 2021_3_7
ID: er4ev0b0
Snippet: Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVIDâ€19). Multiple antiâ€inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this lifeâ€threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limite
Document: Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVIDâ€19). Multiple antiâ€inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this lifeâ€threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVIDâ€19â€related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO(2):FiO(2) ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVIDâ€19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.
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