Anti-inflammatory therapy for COVID-19: effectiveness and predictors of response

Abstract

BACKGROUND: According to the international guidelines and expert opinions, medicines for the treatment of COVID-19 are prescribed off-label; however, the final decision is made by a physician based on an assessment of the risk/benefit ratio for each patient. Global studies of the efficacy and safety of the use of baricitinib, tocilizumab, olokizumab, dexamethasone in the treatment of COVID-19 are ongoing. There is no information about comparative efficacy of these drugs and on the prognosis of their use in COVID-19. AIM: To compare the effects of pre-emptive anti-inflammatory therapy (PAT) with tocilizumab, olokizumab, baricitinib, dexamethasone in patients with COVID-19 to identify response predictors and the choice of the most effective treatment. MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate course of COVID-19 requiring various types of UPT at the Hospital for War Veterans has been carried out. RESULTS: In the study of 229 clinical cases of severe COVID-19, it was found that the most significant predictors of the effects of anticytokine therapy include C-reactive protein (CRP), body mass index (BMI), body temperature, saturation level and the need for a certain type of oxygen support at the start of a therapy, platelet count, hematocrit, neutrophil count, and duration of the disease from its onset to development of signs of a cytokine storm. The probability of recovery in the patients with early appointment of UPT increases by 13%; the need for additional oxygen support increases the risk of mortality by 5.3 times as it increases with the transition to each subsequent level; an increase in the level of CRP by 1% increases the unfavorable prognosis; an increase in D-dimer worsens the prognosis by 16%. CONCLUSION: Based on the statistical data obtained by the method of stepwise regression analysis, was proposed method for predicting the effectiveness of proactive anti-inflammatory therapy in novel coronavirus infections.