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Angelico R, Romano F, Coppola L, Materazzo M, Pedini D, Santicchia MS, Cacciola R, Toti L, Sarmati L, Tisone G. Effects of Anti-COVID-19 Vaccination and Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab in Kidney and Liver Transplant Recipients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2101. [PMID: 38138204 PMCID: PMC10744931 DOI: 10.3390/medicina59122101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Underpowered immune response to vaccines against SARS-CoV-2 was observed in solid organ transplant (SOT) recipients. A novel combination of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) received authorization as pre-exposure prophylaxis (PrEP) in those with reduced response to vaccine. We aimed to evaluate the response rate to COVID-19 vaccination in kidney transplant (KT), compared to liver transplant (LT) recipients, and the efficacy and safety of PrEP with TGM/CGM. Material and Methods: Between March and November 2022, adult KT and LT recipients who had completed the vaccination schedule (3 doses) were tested for anti-SARS-CoV-2 antibodies titer. SOT recipients with anti-SARS-CoV-2 titer ≥ 100 IU/mL were considered protected against infection, while those with titer < 100 UI/mL were defined non-protected. Patients with inadequate response were invited to PrEP. Results: In total, 306 patients were enrolled [KT:197 (64.4%), LT:109 (35.6%)]. After the complete scheme of vaccination, 246 (80.3%) patients developed a protective titer, while 60 (19.6%) did not have a protective titer. KT recipients had a lower rate of protective anti-COVID-19 titer compared to LT patients [149 (75.6%) vs. 97 (89.0%), p = 0.004]. Recipients with non-protective anti-COVID-19 titer received mainly tacrolimus-based regimen associated with mycophenolate mofetil (MMF) (70%) e steroids (46.7%) as maintenance immunosuppression, while those treated with everolimus were associated with higher protective titer. Of 35 (58.3%) patients who received PrEP, within 12 months, 6 (17.1%) (all KT) developed pauci-symptomatic COVID-19 disease, while 15/25 (60%) of non-responders, who did not receive the prophylaxis, developed COVID-19 disease. After PrEP, hospitalization rate was lower (2.8% vs. 16%), and no adverse events, neither graft loss nor rejection, were observed. Conclusions: Despite complete COVID-19 vaccination, SOT recipients might be not protected from the SARS-CoV-2 infection, especially after KT. In non-protected SOT patients, the subsequent pre-exposure prophylaxis with combination of monoclonal antibodies (TGM/CGM) might be an efficacy and safe strategy to prevent COVID-19 severe disease and hospitalization.
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Affiliation(s)
- Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Romano
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luigi Coppola
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Materazzo
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Domiziana Pedini
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Sara Santicchia
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Roberto Cacciola
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Toti
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Loredana Sarmati
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
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Garcia-Carretero R, Vazquez-Gomez O, Ordoñez-Garcia M, Garrido-Peño N, Gil-Prieto R, Gil-de-Miguel A. Differences in Trends in Admissions and Outcomes among Patients from a Secondary Hospital in Madrid during the COVID-19 Pandemic: A Hospital-Based Epidemiological Analysis (2020-2022). Viruses 2023; 15:1616. [PMID: 37515302 PMCID: PMC10384448 DOI: 10.3390/v15071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Spain had some of Europe's highest incidence and mortality rates for coronavirus disease 2019 (COVID-19). This study highlights the impact of the COVID-19 pandemic on daily health care in terms of incidence, critical patients, and mortality. We describe the characteristics and clinical outcomes of patients, comparing variables over the different waves. We performed a descriptive, retrospective study using the historical records of patients hospitalized with COVID-19. We describe demographic characteristics, admissions, and occupancy. Time series allowed us to visualize and analyze trends and patterns, and identify several waves during the 27-month period. A total of 3315 patients had been hospitalized with confirmed COVID-19. One-third of these patients were hospitalized during the first weeks of the pandemic. We observed that 4.6% of all hospitalizations had been admitted to the intensive care unit, and we identified a mortality rate of 9.4% among hospitalized patients. Arithmetic- and semi-logarithmic-scale charts showed how admissions and deaths rose sharply during the first weeks, increasing by 10 every few days. We described a single hospital's response and experiences during the pandemic. This research highlights certain demographic profiles in a population and emphasizes the importance of identifying waves when performing research on COVID-19. Our results can extend the analysis of the impact of COVID-19 and can be applied in other contexts, and can be considered when further analyzing the clinical, epidemiological, or demographic characteristics of populations with COVID-19. Our findings suggest that the pandemic should be analyzed not as a whole but rather in different waves.
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Affiliation(s)
- Rafael Garcia-Carretero
- Department of Internal Medicine, Mostoles University Hospital, 28935 Móstoles, Madrid, Spain
| | - Oscar Vazquez-Gomez
- Department of Internal Medicine, Mostoles University Hospital, 28935 Móstoles, Madrid, Spain
| | - María Ordoñez-Garcia
- Department of Hematology, Mostoles University Hospital, 28935 Móstoles, Madrid, Spain
| | - Noelia Garrido-Peño
- Department of Pharmacy, Mostoles University Hospital, 28935 Móstoles, Madrid, Spain
| | - Ruth Gil-Prieto
- Department of Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Alcorcón, Madrid, Spain
| | - Angel Gil-de-Miguel
- Department of Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Alcorcón, Madrid, Spain
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Mutoh Y, Umemura T, Nishikawa T, Kondo K, Nishina Y, Soejima K, Noguchi Y, Bando T, Ota S, Shimahara T, Hirota S, Hagimoto S, Takei R, Fukihara J, Sasano H, Yamano Y, Yokoyama T, Kataoka K, Matsuda T, Kimura T, Ichihara T, Kondoh Y. Real-World Experience of the Comparative Effectiveness and Safety of Molnupiravir and Nirmatrelvir/Ritonavir in High-Risk Patients with COVID-19 in a Community Setting. Viruses 2023; 15:v15030811. [PMID: 36992519 PMCID: PMC10054616 DOI: 10.3390/v15030811] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Molnupiravir (MOV) and nirmatrelvir/ritonavir (NMV/r) are efficacious oral antiviral agents for patients with the 2019 coronavirus (COVID-19). However, little is known about their effectiveness in older adults and those at high risk of disease progression. This retrospective single-center observational study assessed and compared the outcomes of COVID-19 treated with MOV and NMV/r in a real-world community setting. We included patients with confirmed COVID-19 combined with one or more risk factors for disease progression from June to October 2022. Of 283 patients, 79.9% received MOV and 20.1% NMV/r. The mean patient age was 71.7 years, 56.5% were men, and 71.7% had received ≥3 doses of vaccine. COVID-19-related hospitalization (2.8% and 3.5%, respectively; p = 0.978) or death (0.4% and 3.5%, respectively; p = 0.104) did not differ significantly between the MOV and NMV/r groups. The incidence of adverse events was 2.7% and 5.3%, and the incidence of treatment discontinuation was 2.7% and 5.3% in the MOV and NMV/r groups, respectively. The real-world effectiveness of MOV and NMV/r was similar among older adults and those at high risk of disease progression. The incidence of hospitalization or death was low.
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Affiliation(s)
- Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto 489-8642, Japan
| | - Takumi Umemura
- Department of Infection Control Team, Tosei General Hospital, Seto 489-8642, Japan
| | - Takeshi Nishikawa
- Department of Infectious Diseases, Tosei General Hospital, Seto 489-8642, Japan
| | - Kaho Kondo
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Yuta Nishina
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Kazuaki Soejima
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Yoichiro Noguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Tomohiro Bando
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Sho Ota
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Tatsuki Shimahara
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Shuko Hirota
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Satoshi Hagimoto
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Reoto Takei
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Jun Fukihara
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Hajime Sasano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
| | - Toshihiko Ichihara
- Department of Infectious Diseases, Tosei General Hospital, Seto 489-8642, Japan
- Department of Infection Control Team, Tosei General Hospital, Seto 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan
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Nesterova IV, Atazhakhova MG, Teterin YV, Matushkina VA, Chudilova GA, Mitropanova MN. THE ROLE OF NEUTROPHIL EXTRACELLULAR TRAPS (NETS)
IN THE IMMUNOPATHOGENESIS OF SEVERE COVID-19: POTENTIAL IMMUNOTHERAPEUTIC STRATEGIES REGULATING NET FORMATION AND ACTIVITY. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023. [DOI: 10.15789/2220-7619-tro-2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The role of neutrophil granulocytes (NG) in the pathogenesis of COVID-19 is associated with the recruitment of NG into inflammatory foci, activation of their functions and enhanced formation of neutrophil extracellular networks (NETs). In this review, we analyzed a fairly large volume of scientific literature devoted to the peculiarities of the formation of NETs, their role in the pathogenesis of COVID-19, participation in the occurrence of immunothrombosis, vasculitis, acute respiratory distress syndrome, cytokine storm syndrome, multi-organ lesions. Convincing data are presented that clearly indicate the significant involvement of NETs in the immunopathogenesis of COVID-19 and the associated severe complications resulting from the intensification of the inflammation process, which is key for the course of infection caused by the SARS-CoV-2 virus. The presented role of NG and NETs, along with the role of other immune system cells and pro-inflammatory cytokines, is extremely important in understanding the development of an overactive immune response in severe COVID-19. The obtained scientific results, available today, allow identifying the possibilities of regulatory effects on hyperactivated NG, on the formation of NETs at various stages and on limiting the negative impact of already formed NETs on various tissues and organs. All of the above should help in the creation of new, specialized immunotherapy strategies designed to increase the chances of survival, reduce the severity of clinical manifestations in patients with COVID-19, as well as significantly reduce mortality rates. Currently, it is possible to use existing drugs and a number of new drugs are being developed, the action of which can regulate the amount of NG, positively affect the functions of NG and limit the intensity of NETs formation. Continuing research on the role of hyperactive NG and netosis, as well as understanding the mechanisms of regulation of the phenomenon of formation and restriction of NETs activity in severe COVID-19, apparently, are a priority, since in the future the new data obtained could become the basis for the development of targeted approaches not only to immunotherapy aimed at limiting education and blocking negative effects already formed NETs in severe COVID-19, but also to immunotherapy, which could be used in the complex treatment of other netopathies, first of all, autoimmune diseases, auto-inflammatory syndromes, severe purulent-inflammatory processes, including bacterial sepsis and hematogenous osteomyelitis.
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Jamil Z, Khan AA, Yousuf H, Khalid K, Abbasi SM, Waheed Y. Role of Therapeutic Plasmapheresis in SARS-CoV-2 Induced Cytokine Release Syndrome: A Retrospective Cohort Study on COVID-19 Patients. Int J Gen Med 2022; 15:4907-4916. [PMID: 35585996 PMCID: PMC9109892 DOI: 10.2147/ijgm.s362151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cytokine release syndrome (CRS) significantly contributes to the pathophysiology and progression of COVID-19. It is speculated that therapeutic plasma exchange (TPE) can dampen CRS via elimination of pathogenic cytokines. Objectives The study is intended to compare the outcomes of COVID-19 patients with CRS treated with TPE and standard care (SC) to their counterparts receiving SC alone. Methodology A retrospective cohort study of severe COVID-19 confirmed patients presenting with CRS and admitted to the medical ICU was conducted between March and August 2021. Using case-control (CC) matching 1:1, 162 patients were selected and divided into two equal groups. The primary outcome was 28-day in-hospital survival analysis in severe COVID-19 patients with CRS. However, secondary outcomes included the effect of plasmapheresis on inflammatory markers, the need for mechanical ventilation, the rate of extubation, and the duration of survival. Results After CC matching, the study cohort had a mean age of 55.41 (range 56.41±11.56 in TP+SC and 54.42±8.94 in SC alone; p=0.22). There were 25.95% males and 74.05% females in both groups. The mean time from first day of illness to hospitalization was 6.53±2.18 days. The majority of patients with CRS had comorbid conditions (75.9%). Diabetes mellitus was the most common comorbidity (40.1%), followed by hypertension (25.3%), and chronic kidney disease (21%). Notable reduction in some inflammatory markers (D-dimers, LDH, CRP and serum ferritin) (p<0.0001) was observed in the group that received TPE+SC. Moreover, the patients in the plasmapheresis plus standard care group required relatively less mechanical ventilation as compared to the group receiving SC alone (46.9% vs 58.1%, respectively; p>0.05). The rate of extubation in the TP+SC group vs SC alone was 60.5% vs 44.7%, respectively (p>0.05). Similarly, the mortality percentages in both groups were 19.8% and 24.7%, respectively. Conclusion For this particular group of matched patients with COVID-19-induced CRS, TPE+SC was linked with relatively better overall survival, early extubation, and earlier discharge compared to SC alone. As these results were not statistically significant, multi-centered randomized control trials are needed to further elaborate the role of therapeutic plasmapheresis in COVID-19 induced CRS.
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Affiliation(s)
- Zubia Jamil
- Department of Medicine, Foundation University Medical College, Foundation University Islamabad, Islamabad, 44000, Pakistan
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Hamid Yousuf
- Department of Medicine, Betsi Cadwaladr University Health Board, Wrexham, North Wales, UK
| | - Kashaf Khalid
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, 44000, Pakistan
| | | | - Yasir Waheed
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, 44000, Pakistan
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Ligi D, Maniscalco R, Plebani M, Lippi G, Mannello F. Do Circulating Histones Represent the Missing Link among COVID-19 Infection and Multiorgan Injuries, Microvascular Coagulopathy and Systemic Hyperinflammation? J Clin Med 2022; 11:jcm11071800. [PMID: 35407410 PMCID: PMC8999947 DOI: 10.3390/jcm11071800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
Several studies shed light on the interplay among inflammation, thrombosis, multi-organ failures and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Increasing levels of both free and/or circulating histones have been associated to coronavirus disease 2019 (COVID-19), enhancing the risk of heart attack and stroke with coagulopathy and systemic hyperinflammation. In this view, by considering both the biological and clinical rationale, circulating histones may be relevant as diagnostic biomarkers for stratifying COVID-19 patients at higher risk for viral sepsis, and as predictive laboratory medicine tool for targeted therapies.
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Affiliation(s)
- Daniela Ligi
- Unit of Clinical Biochemistry, Department of Biomolecular Sciences-DISB, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Rosanna Maniscalco
- Unit of Clinical Biochemistry, Department of Biomolecular Sciences-DISB, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, 37134 Verona, Italy
| | - Ferdinando Mannello
- Unit of Clinical Biochemistry, Department of Biomolecular Sciences-DISB, University of Urbino Carlo Bo, 61029 Urbino, Italy
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Antibiotics and Therapeutic Agent Prescription in COVID-19 Management. Antibiotics (Basel) 2022; 11:antibiotics11040423. [PMID: 35453175 PMCID: PMC9025734 DOI: 10.3390/antibiotics11040423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/03/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, only few therapeutic options have been approved for the treatment of COVID-19 with substantial evidence [...]
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