Comparative analysis of immunosuppressive therapy effectiveness in COVID-19 patients

Abstract

The objective of our study was the analysis of using immunosuppressive therapy in patients with COVID-19 at the Clinic of the Bashkir State Medical University. Material and methods — We conducted the analysis of clinical and laboratory parameters of inflammatory response in 322 patients with COVID-19 who received tocilizumab, baricitinib, high doses of dexamethasone, or standard therapy. Results — There was an increase in the levels of leukocytes (p=0.04) and neutrophils (p=0.002) in patients receiving tocilizumab, compared with standard therapy, on days 5 and 10 of a hospital stay. The level of C-reactive protein was initially elevated in all patients, but by day 5 of hospitalization it was significantly higher in patients treated with tocilizumab and baricitinib (p=0.0019 and p=0.013, respectively), compared with high-dose glucocorticoid therapy and standard treatment, against which the normalization of parameter values was noted. The neutrophil-to-lymphocyte ratio increased in the group of patients receiving tocilizumab and high-dose glucocorticoid therapy on day 5 of hospitalization (p=0.017 and p=0.004). When assessing the dynamics of pneumonia, based on computed tomography data, the median of changes exhibited an increase in the volume of lung damage in all groups, compared with the baseline level. Conclusion — Tocilizumab in the form of monotherapy effectively reduced inflammation, while the efficacy of baricitinib for stopping the cytokine storm in monotherapy was insufficient. Based on CT data, both target drugs did not stop the progression of lung lesions on day 5.