Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord experience
Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord experience
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DOI：
10.26355/eurrev_202004_20875
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发表时间：
2020-04-01
影响因子：
3.3
通讯作者：
Facchini, G.
中科院分区：
文献类型：
--
作者：
Diurno, F.;Numis, F. G.;Facchini, G.
目的：SARS-CoV-2（严重急性呼吸综合征冠状病毒2）相关肺炎，简称COVID-19（冠状病毒病19），是一种具有高发病率和死亡率的突发公共卫生事件，并且没有批准的特异性药物治疗方法。在本病例系列中，我们旨在报告用eculizumab抗补体C5治疗在那不勒斯2 Nord重症监护病房（ICU）入住的COVID-19患者中获得的初步数据。患者和方法：这是一个确诊为SARS-CoV2感染和严重肺炎或急性呼吸窘迫综合征（ARDS）的患者的病例系列，他们接受了最多4次eculizumab作为标签外药物的输注治疗。同时给予依诺肝素4000 IU/天皮下注射抗凝治疗，洛匹那韦800 mg/天+利托那韦200 mg/天，羟氯喹400 mg/天，头孢曲松2 g/天IV，维生素C6 g/天，连用4天，给予无创通气（NIV）。结果：我们治疗了4例因严重肺炎或ARDS入住重症监护病房的COVID-19患者。所有患者经eculizumab治疗后均成功康复。Eculizumab诱导炎症标志物下降。平均C反应蛋白水平从14.6 mg/dl降至3.5 mg/dl，平均病程为12.8天。结论：Eculizumab有潜力成为治疗COVID-19重症病例的关键药物。我们的研究结果支持eculizumab作为COVID-19的标签外治疗，等待正在进行的SOLID-C19试验的确认。
OBJECTIVE: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referred to as COVID-19 (Coronavirus Disease 19), is a public health emergency as it carries high morbidity, mortality, and has no approved specific pharmacological treatments. In this case series, we aimed to report preliminary data obtained with anti-complement C5 therapy with eculizumab in COVID-19 patients admitted to intensive care unit (ICU) of ASL Napoli 2 Nord.PATIENTS AND METHODS: This is a case series of patients with a confirmed diagnosis of SARS-CoV2 infection and severe pneumonia or ARDS who were treated with up to 4 infusions of eculizumab as an off-label agent. Patients were also treated with anticoagulant therapy with Enoxaparin 4000 IU/day via subcutaneous injection, antiviral therapy with Lopinavir 800 mg/day + Ritonavir 200 mg/day, hydroxychloroquine 400 mg/day, ceftriaxone 2 g/day IV, vitamine C6 g/day for 4 days, and were on Non-Invasive Ventilation (NIV).RESULTS: We treated four COVID-19 patients admitted to the intensive care unit because of severe pneumonia or ARDS. All patients successfully recovered after treatment with eculizumab. Eculizumab induced a drop in inflammatory markers. Mean C Reactive Protein levels dropped from 14.6 mg/dl to 3.5 mg/dl and the mean duration of the disease was 12.8 days.CONCLUSIONS: Eculizumab has the potential to be a key player in treatment of severe cases of COVID-19. Our results support eculizumab use as an off-label treatment of COVID-19, pending confirmation from the ongoing SOLID-C19 trial.