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Pomponio G, Ferrarini A, Bonifazi M, Moretti M, Salvi A, Giacometti A, Tavio M, Titolo G, Morbidoni L, Frausini G, Onesta M, Amico D, Rocchi MLB, Menzo S, Zuccatosta L, Mei F, Menditto V, Svegliati S, Donati A, D'Errico MM, Pavani M, Gabrielli A. Tocilizumab in COVID-19 interstitial pneumonia. J Intern Med 2021; 289:738-746. [PMID: 33511686 PMCID: PMC8013903 DOI: 10.1111/joim.13231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.
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Affiliation(s)
- G Pomponio
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Ferrarini
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Bonifazi
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Moretti
- SOD Medicina di Laboratorio Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Salvi
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Giacometti
- Clinica di Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Tavio
- Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G Titolo
- Medicina di Urgenza, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - L Morbidoni
- Medicina Interna, Ospedale di Senigallia, Senigallia, Italy
| | - G Frausini
- Medicina Interna, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - M Onesta
- Medicina Interna, Ospedale di Fabriano, Fabriano, Italy
| | - D Amico
- Pneumologia, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - M L B Rocchi
- Statistica Medica, Dipartimento di Scienze Biomolecolari, Università di Urbino, Urbino, Italy
| | - S Menzo
- Virologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - L Zuccatosta
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Mei
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - V Menditto
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Svegliati
- Clinica Medica, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - A Donati
- Clinica di Rianimazione, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M M D'Errico
- Dip. Scienze biomediche e sanità pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - M Pavani
- Laboratorio di Patologia Sperimentale, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - A Gabrielli
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy.,Clinica Medica, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
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Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L, Lawrence VA. Garlic shows promise for improving some cardiovascular risk factors. Arch Intern Med 2001; 161:813-24. [PMID: 11268223 DOI: 10.1001/archinte.161.6.813] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To summarize the effects of garlic on several cardiovascular-related factors and to note its adverse effects. METHODS English and non-English citations were identified from 11 electronic databases, references, manufacturers, and experts from January 1966 through February 2000 (depending on the database searched). Reports of cardiovascular-related effects were limited to randomized controlled trials lasting at least 4 weeks. Reports of adverse effects were not limited by study design. From 1798 pertinent records, 45 randomized trials and 73 additional studies reporting adverse events were identified. Two physicians abstracted outcomes and assessed adequacy of randomization, blinding, and handling of dropouts. Standardized mean differences of lipid outcomes from placebo-controlled trials were adjusted for baseline differences and pooled using random effects methods. RESULTS Compared with placebo, garlic preparations may lead to small reductions in the total cholesterol level at 1 month (range of average pooled reductions, 0.03-0.45 mmol/L [1.2-17.3 mg/dL]) and at 3 months (range of average pooled reductions 0.32-0.66 mmol/L [12.4-25.4 mg/dL]), but not at 6 months. Changes in low-density lipoprotein levels and triglyceride levels paralleled total cholesterol level results; no statistically significant changes in high-density lipoprotein levels were observed. Trials also reported significant reductions in platelet aggregation and mixed effects on blood pressure outcomes. No effects on glycemic-related outcomes were found. Proven adverse effects included malodorous breath and body odor. Other unproven effects included flatulence, esophageal and abdominal pain, allergic reactions, and bleeding. CONCLUSIONS Trials suggest possible small short-term benefits of garlic on some lipid and antiplatelet factors, insignificant effects on blood pressure, and no effect on glucose levels. Conclusions regarding clinical significance are limited by the marginal quality and short duration of many trials and by the unpredictable release and inadequate definition of active constituents in study preparations.
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Affiliation(s)
- R T Ackermann
- Audie L. Murphy Memorial Veterans Hospital, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78284, USA
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Mulrow C, Lawrence V, Ackermann R, Gilbert Ramirez G, Morbidoni L, Aguilar C, Arterburn J, Block E, Chiquette E, Gardener C, Harris M, Heidenreich P, Mullins D, Richardson M, Russell N, Vickers A, Young V. Garlic: effects on cardiovascular risks and disease, protective effects against cancer, and clinical adverse effects. Evid Rep Technol Assess (Summ) 2000:1-4. [PMID: 11089496 PMCID: PMC4781634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Pomponio G, Della Costanza OP, Ortolani S, Morbidoni L, Contadini S, Pettinelli F, Natalini M, Danieli G. [Research and evaluation of Internet resources for the practice and teaching of nursing]. Prof Inferm 2000; 53:105-10. [PMID: 11272085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Recent changes in the Italian health care system are causing a complex redefinition of the traditional principles of nursing. Among the new principles that are being proposed, the implementation of a clinical practice based on the evidence generated by the medical research community appears to be prominent. However, objective time constraints in finding and evaluating the available information have often hampered the achievement of this highly desirable goal. In this perspective, exploitation of the intrinsic quickness of the internet-based information retrieval systems has the potential to effectively circumvent the problem. To provide nurses with a proper training in a timely search and evaluation of on-line data, we have designed and developed a guide to those websites providing clinical information. This guide consists of (1) reviews of existing websites, and (2) proposal of a standardized model for selection, evaluation, and description of existing and newly appearing websites. We believe that this guide might increase the capability of nurses to effectively exploit the medical and scientific information resources available on the net.
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Affiliation(s)
- G Pomponio
- Istituto di Clinica Medica, Ematologia ed Immunologia Clinica, Università di Ancona
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Mulrow C, Lawrence V, Jacobs B, Dennehy C, Sapp J, Ramirez G, Aguilar C, Montgomery K, Morbidoni L, Arterburn JM, Chiquette E, Harris M, Mullins D, Vickers A, Flora K. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects. Evid Rep Technol Assess (Summ) 2000:1-3. [PMID: 11262867 PMCID: PMC4781343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Fratini M, Morbidoni L, Natalini M, Pomponio G. [Guidelines: research in the web, critical assessment, clinical application]. Recenti Prog Med 1999; 90:643-7. [PMID: 10676102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Fratini
- Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università, Ancona.
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