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Chandrakala S, Toshniwal M, Halvawala M, Padwal N, Sidharthan N, Malhotra P, Prashantha B, Ballikar R, Shah S, Apte S, Viswanathan TK, Ramanan V, Sharma A, Pawar D, Pawar R, Shahavi V. Efficacy and Safety of Biosimilar Romiplostim Versus Innovator Romiplostim in Patients with Chronic Immune Thrombocytopenia. Indian J Hematol Blood Transfus 2023; 39:435-441. [PMID: 37304488 PMCID: PMC10247600 DOI: 10.1007/s12288-022-01602-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Romiplostim is a Food and Drug Administration (FDA)-approved therapy for immune thrombocytopenia (ITP). Biosimilar is a biological product that has no clinical meaningful difference from an existing FDA-approved reference product. It has a potential of lowering health-care-related cost. Biosimilar of romiplostim can be made available to patients with ITP at a low cost and can be beneficial in providing the best therapy. Thus, the efficacy and safety of biosimilar romiplostim (ENZ110) was compared with innovator romiplostim (Nplate) with respect to platelet response in patients with chronic ITP. This was a prospective, multicenter, randomized, and double-blind clinical trial. Patients with chronic ITP, aged 18-65 years, were enrolled in a study and were randomized to receive either ENZ110 or Nplate in a 3:1 ratio for a treatment period of 12 weeks, respectively. After completion of the treatment period, the patients were followed-up for one week to evaluate the platelet response and to monitor the adverse events (AEs). Over the duration of 12 weeks, platelet response of > 50 × 109/L was achieved in 85.3% patients treated with ENZ110 and in 75.0% patients treated with Nplate in per protocol population. In intent-to-treat population, 83.8% patients with ENZ110 and 76.9% patients with Nplate achieved a platelet response of > 50 × 109/L. In the ENZ110 group, 111 AEs were recorded in 66.7% patients, while 18 AEs were reported in 61.5% patients in the Nplate group. The study demonstrated non-inferiority with comparable efficacy and safety between biosimilar romiplostim and innovator romiplostim in patients with chronic ITP. Trial registration number and date of registration: CTRI/2019/04/018614.
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Affiliation(s)
- S. Chandrakala
- Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | | - Pankaj Malhotra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B. Prashantha
- Kasturba Medical College (KMC) Hospital, Mangalore, India
| | - Riya Ballikar
- Criticare Hospital and Research Institute, Nagpur, India
| | | | | | | | - Vijay Ramanan
- Grant Medical Foundation Ruby Hall Clinic, Pune, India
| | - Akhilesh Sharma
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Dattatray Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Roshan Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
| | - Vinayaka Shahavi
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg,Lower Parel, Mumbai, India
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Chandrakala S, Toshniwal M, Halvawala M, Padwal N, Sidharthan N, Malhotra P, Prashantha B, Ballikar R, Shah S, Apte S, Viswanathan TK, Ramanan V, Sharma A, Pawar D, Pawar R, Shahavi V. Correction to: Efficacy and Safety of Biosimilar Romiplostim Versus Innovator Romiplostim in Patients with Chronic Immune Thrombocytopenia. Indian J Hematol Blood Transfus 2023; 39:522-523. [PMID: 37304472 PMCID: PMC10247629 DOI: 10.1007/s12288-023-01635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
[This corrects the article DOI: 10.1007/s12288-022-01602-5.].
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Affiliation(s)
- S. Chandrakala
- Seth G. S. Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | | - Pankaj Malhotra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B. Prashantha
- Kasturba Medical College (KMC) Hospital, Mangalore, India
| | - Riya Ballikar
- Criticare Hospital and Research Institute, Nagpur, India
| | | | | | | | - Vijay Ramanan
- Grant Medical Foundation Ruby Hall Clinic, Pune, India
| | - Akhilesh Sharma
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg, Lower Parel, Mumbai, India
| | - Dattatray Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg, Lower Parel, Mumbai, India
| | - Roshan Pawar
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg, Lower Parel, Mumbai, India
| | - Vinayaka Shahavi
- Medical Affairs Department, Alkem Laboratories Limited, Alkem House, Senapati Bapat Marg, Lower Parel, Mumbai, India
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Sundar U, Karnik ND, Mukhopadhyay A, Darole P, Kolte S, Bansal A, Gokhale YA, Asole D, Joshi A, Pednekar S, Chavan S, Trivedi T, Padwal N, Kalekar L, Londhe C. COVID-19 Associated Stroke-A Single Centre Experience. J Assoc Physicians India 2021; 69:11-12. [PMID: 34472782] [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: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020. METHODS We recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes. RESULTS There were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years; age range 17-91; F/M=20/38; 24% (14/58) aged ≤40; 51% (30/58) hypertensive; 36% (21/58) diabetic; 41% (24/58) with O2 saturation <95% at admission; 32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49; 73.5%), followed by vertebrobasilar (7/49; 14.3%) and both (6/49; 12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). 'Early stroke' (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low Glasgow coma score (GCS) and requirement for increasing intensity of respiratory support predicted in-hospital mortality. CONCLUSIONS We had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission.
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Affiliation(s)
- Uma Sundar
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra; Corresponding Author
| | - Niteen D Karnik
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Amita Mukhopadhyay
- Associate Professor, Community Medicine, Dr Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Ramanagara District, Karnataka
| | - Pramod Darole
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Shaonak Kolte
- Research Assistant, Medicine, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Ashank Bansal
- Assistant Professor, Radiology, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Yojana A Gokhale
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Dnaneshwar Asole
- Assistant Professor, Medicine, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Anagha Joshi
- Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Sangeeta Pednekar
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Swati Chavan
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Trupti Trivedi
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Namita Padwal
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Lalana Kalekar
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
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Gokhale Y, Mehta R, Kulkarni U, Karnik N, Gokhale S, Sundar U, Chavan S, Kor A, Thakur S, Trivedi T, Kumar N, Baveja S, Wadal A, Kolte S, Deolankar A, Pednekar S, Kalekar L, Padiyar R, Londhe C, Darole P, Pol S, Gokhe SB, Padwal N, Pandey D, Yadav D, Joshi A, Badgujar H, Trivedi M, Shah P, Bhavsar P. Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India. BMC Infect Dis 2021; 21:241. [PMID: 33673818 PMCID: PMC7934984 DOI: 10.1186/s12879-021-05912-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.
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Affiliation(s)
- Yojana Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India.
| | - Rakshita Mehta
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uday Kulkarni
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Karnik
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sushant Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uma Sundar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Swati Chavan
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Akshay Kor
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sonal Thakur
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Trupti Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Naveen Kumar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aniket Wadal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Shaonak Kolte
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aukshan Deolankar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sangeeta Pednekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Lalana Kalekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Rupal Padiyar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Charulata Londhe
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Pramod Darole
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Pol
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | | | - Namita Padwal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dharmendra Pandey
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dhirendra Yadav
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Anagha Joshi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Harshal Badgujar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Mayuri Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Priyanshu Shah
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Prerna Bhavsar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
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Trivedi T, Bajaj P, Moulick N, Padwal N. Mortality in Malaria: Intensive Care (MIMIC). J Assoc Physicians India 2018; 66:16-20. [PMID: 30347945] [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: 06/08/2023]
Abstract
BACKGROUND While global incidence of malaria has fallen in last decade, it continues to be an important cause of mortality and morbidity in acutely ill febrile patients. Many patients with complicated malaria require ICU care. In past it was believed that vivax is a benign form of malaria, but now all complications of malaria are reported in vivax. . AIMS AND OBJECTIVES 1. To find out proportion of patients with plasmodium vivax and plasmodium falciparum malaria requiring treatment in Medical ICU. 2. To compare clinical profile and severity of illness in these patients. 3. To study treatment received including organ support requirement in these patients and compare outcome in patients with vivax and falciparum malaria. RESULTS During study period total 932 patients were diagnosed as confirmed malaria (601 vivax, 240 falciparum and 91 mixed) and 107 (vivax 74, falciparum 20, mixed 13) required ICU admission. Common symptoms observed apart from fever were, oliguria (48), dyspnea(41), bleeding (29), hemoptysis (15) and petechial rash (13). Mean BUN and creatinine and PT INR of falciparum/mixed malaria patients was significantly higher and HCO3 and pH significantly lower than vivax patients. But PaO2/FiO2 of vivax patient was significantly lower as compared falciparum/mixed patients. There was no significant difference between two groups with regards to requirement of supportive treatment like inotropes (11/70 vs 5/30, p=0.858), mechanical ventilation (28/70 vs 7/30, p=0.17), platelet transfusion (24/70 vs 9/30, p=0.853) and renal replacement therapy (5/70 vs 3/30 p=0.936). Out of 100 patients, 21 patients expired. Mortality in mixed malaria group (4/12, 33.3%) and vivax group ( 16/70, 22.9%) was more as compared to falciparum group (1/18, 5.6%, < 0.05). CONCLUSIONS Incidence of Plasmodium vivax malaria is higher compared to falciparum malaria in hospitalized patients and higher percentage of these need ICU care. Most common complications of malaria are thrombocytopenia followed by renal failure, hepatic dysfunction, ARDS, shock and cerebral dysfunction respectively. Mortality was higher in vivax and mixed malaria compared to falciparum. Higher SOFA score (Sequential organ failure assessment score), lower GCS score (Glasgow coma scale), hypotension, ARDS and metabolic acidosis are predictors of mortality.
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Affiliation(s)
| | | | | | - Namita Padwal
- Associate professor, Department of Medicine, LTM Medical College and General Hospital, Mumbai, Maharashtra
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