Cargando…

Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai

Introduction: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory dis...

Descripción completa

Detalles Bibliográficos
Autores principales: Isaac, Bindu, Hazari, Komal, Harb, Deemah K, Mallick, Ayaz K, Abdelkareem, Widad, Ammar, Abeir, Gergawi, Taghrid, Saeed Al Zahmi, Eiman, Khamis, Amar H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977079/
https://www.ncbi.nlm.nih.gov/pubmed/36874696
http://dx.doi.org/10.7759/cureus.34395
_version_ 1784899217814192128
author Isaac, Bindu
Hazari, Komal
Harb, Deemah K
Mallick, Ayaz K
Abdelkareem, Widad
Ammar, Abeir
Gergawi, Taghrid
Saeed Al Zahmi, Eiman
Khamis, Amar H
author_facet Isaac, Bindu
Hazari, Komal
Harb, Deemah K
Mallick, Ayaz K
Abdelkareem, Widad
Ammar, Abeir
Gergawi, Taghrid
Saeed Al Zahmi, Eiman
Khamis, Amar H
author_sort Isaac, Bindu
collection PubMed
description Introduction: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women. Methodology: A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. Result: On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted. Conclusion: Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters.
format Online
Article
Text
id pubmed-9977079
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-99770792023-03-02 Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai Isaac, Bindu Hazari, Komal Harb, Deemah K Mallick, Ayaz K Abdelkareem, Widad Ammar, Abeir Gergawi, Taghrid Saeed Al Zahmi, Eiman Khamis, Amar H Cureus Obstetrics/Gynecology Introduction: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women. Methodology: A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. Result: On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted. Conclusion: Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters. Cureus 2023-01-30 /pmc/articles/PMC9977079/ /pubmed/36874696 http://dx.doi.org/10.7759/cureus.34395 Text en Copyright © 2023, Isaac et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Obstetrics/Gynecology
Isaac, Bindu
Hazari, Komal
Harb, Deemah K
Mallick, Ayaz K
Abdelkareem, Widad
Ammar, Abeir
Gergawi, Taghrid
Saeed Al Zahmi, Eiman
Khamis, Amar H
Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title_full Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title_fullStr Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title_full_unstemmed Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title_short Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai
title_sort maternal and fetal outcome in pregnant women with critical covid-19 treated with tocilizumab in a tertiary care hospital in dubai
topic Obstetrics/Gynecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977079/
https://www.ncbi.nlm.nih.gov/pubmed/36874696
http://dx.doi.org/10.7759/cureus.34395
work_keys_str_mv AT isaacbindu maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT hazarikomal maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT harbdeemahk maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT mallickayazk maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT abdelkareemwidad maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT ammarabeir maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT gergawitaghrid maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT saeedalzahmieiman maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai
AT khamisamarh maternalandfetaloutcomeinpregnantwomenwithcriticalcovid19treatedwithtocilizumabinatertiarycarehospitalindubai