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Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan

The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with p...

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Autores principales: Nasir, Noreen, Tajuddin, Salma, Khaskheli, Sarah, Khan, Naveera, Niamatullah, Hammad, Nasir, Nosheen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794194/
https://www.ncbi.nlm.nih.gov/pubmed/35085312
http://dx.doi.org/10.1371/journal.pone.0262608
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author Nasir, Noreen
Tajuddin, Salma
Khaskheli, Sarah
Khan, Naveera
Niamatullah, Hammad
Nasir, Nosheen
author_facet Nasir, Noreen
Tajuddin, Salma
Khaskheli, Sarah
Khan, Naveera
Niamatullah, Hammad
Nasir, Nosheen
author_sort Nasir, Noreen
collection PubMed
description The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in combination and the most frequent combination was methylprednisolone with azithromycin. Overall in-hospital mortality was 13.65% of patients. Mortality was found to be independently associated with age greater than or equal to 60 years (OR = 4.98; 95%CI: 2.78–8.91), critical illness on admission (OR = 13.75; 95%CI: 7.27–25.99), use of hydrocortisone (OR = 12.56; 95%CI: 6.93–22.7), Ferritin> = 1500(OR = 2.07; 95%CI: 1.18–3.62), Creatinine(OR = 2.33; 95%CI: 1.31–4.14) and D-Dimer> = 1.5 (OR = 2.27; 95%CI: 1.26–4.07). None of the medications whether used as monotherapy or in combination were found to have a mortality benefit. Our study highlights the desperate need for an effective drug for the management of critical COVID-19 which necessitates usage of multiple drug combinations in patients particularly Azithromycin which has long term implications for antibiotic resistance particularly in low-middle income countries.
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spelling pubmed-87941942022-01-28 Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan Nasir, Noreen Tajuddin, Salma Khaskheli, Sarah Khan, Naveera Niamatullah, Hammad Nasir, Nosheen PLoS One Research Article The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in combination and the most frequent combination was methylprednisolone with azithromycin. Overall in-hospital mortality was 13.65% of patients. Mortality was found to be independently associated with age greater than or equal to 60 years (OR = 4.98; 95%CI: 2.78–8.91), critical illness on admission (OR = 13.75; 95%CI: 7.27–25.99), use of hydrocortisone (OR = 12.56; 95%CI: 6.93–22.7), Ferritin> = 1500(OR = 2.07; 95%CI: 1.18–3.62), Creatinine(OR = 2.33; 95%CI: 1.31–4.14) and D-Dimer> = 1.5 (OR = 2.27; 95%CI: 1.26–4.07). None of the medications whether used as monotherapy or in combination were found to have a mortality benefit. Our study highlights the desperate need for an effective drug for the management of critical COVID-19 which necessitates usage of multiple drug combinations in patients particularly Azithromycin which has long term implications for antibiotic resistance particularly in low-middle income countries. Public Library of Science 2022-01-27 /pmc/articles/PMC8794194/ /pubmed/35085312 http://dx.doi.org/10.1371/journal.pone.0262608 Text en © 2022 Nasir et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Nasir, Noreen
Tajuddin, Salma
Khaskheli, Sarah
Khan, Naveera
Niamatullah, Hammad
Nasir, Nosheen
Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title_full Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title_fullStr Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title_full_unstemmed Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title_short Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan
title_sort clinical outcomes of immunomodulatory therapies in the management of covid-19: a tertiary-care experience from pakistan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794194/
https://www.ncbi.nlm.nih.gov/pubmed/35085312
http://dx.doi.org/10.1371/journal.pone.0262608
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