medigraphic.com
Colegio de Medicina Interna de México.

2020, Número 4

<< Anterior Siguiente >>

Med Int Mex 2020; 36 (4)


Neumonía grave por COVID-19 curada con prono consciente y tocilizumab. Comunicación de un caso y revisión de la evidencia terapéutica farmacológica

Del Carpio-Orantes L, González-Segovia O, Mojica-Ríos F, Suárez-Mandujano MP, Martínez-Rojas M, Cortés-Román JS, Jiménez-Flores OR, Pascual-Epigmenio S, Ramírez-Rojas R, Ataxca-González MA

Idioma: Español
Referencias bibliográficas: 37
Paginas: 585-595
Archivo PDF: 380.54 Kb.


RESUMEN

Antecedentes: A finales de diciembre de 2019 se describió el primer brote de neumonías atípicas en Wuhan, China, con la posterior detección del agente del género coronavirus, hoy día denominado SARS-CoV-2 y su cuadro COVID-19.
Caso clínico: Paciente masculino de 41 años de edad afectado por COVID-19 en forma de neumonía grave (CORADS 6), que no tuvo respuesta a fármacos convencionales y solo agregaron comorbilidad (prolongación del segmento QT), por lo que ameritó estrategia ventilatoria no invasiva en modalidad prono conciente aunado a administración de tocilizumab, con adecuada evolución clínica, gasométrica y tomográfica; actualmente el paciente cursa sin secuelas pulmonares.
Conclusiones: Aún faltan muchos estudios clínicos controlados para poder demostrar la utilidad concreta de un fármaco específico y la evidencia actual hace abandonar esquemas propuestos inicialmente; sin embargo, algunos fármacos aún pudieran tener cierta utilidad en casos leves a moderados.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Fung TS, Liu DX. Human Coronavirus: Host-pathogen interaction. Annu Rev Microbiol 2019; 73: 529‐557. doi: 10.1146/annurev-micro-020518-115759

  2. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention [published online ahead of print, 2020 Feb 24]. JAMA 2020; 10.1001/jama.2020.2648. doi: 10.1001/jama.2020.2648

  3. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez- Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623. doi: 10.1016/j. tmaid.2020.101623

  4. Mercuro NJ, Yen CF, Shim DJ, et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19) [published online ahead of print, 2020 May 1]. JAMA Cardiol 2020; e201834. doi: 10.1001/jamacardio. 2020.1834

  5. Gérard A, Romani S, Fresse A, et al. “Off-label” use of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine in COVID-19: A survey of cardiac adverse drug reactions by the French Network of Pharmacovigilance Centers [published online ahead of print, 2020 May 7]. Therapie 2020;S0040-5957(20)30091-3. doi: 10.1016/j. therap.2020.05.002

  6. Baron SA, Devaux C, Colson P, Raoult D, Rolain JM. Teicoplanin: an alternative drug for the treatment of COVID-19? Int J Antimicrob Agents 2020; 55(4): 105944. doi: 10.1016/j. ijantimicag.2020.105944

  7. Yousefi B, Valizadeh S, Ghaffari H, Vahedi A, Karbalaei M, Eslami M. A global treatment for coronaviruses including COVID-19 [published online ahead of print, 2020 May 11]. J Cell Physiol 2020; 10.1002/jcp.29785. doi: 10.1002/ jcp.29785

  8. Vankadari N. Arbidol: A potential antiviral drug for the treatment of SARS-CoV-2 by blocking trimerization of the spike glycoprotein [published online ahead of print, 2020 Apr 28]. Int J Antimicrob Agents 2020;105998. doi:10.1016/j.ijantimicag.2020.105998

  9. Cao YC, Deng QX, Dai SX. Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: An evaluation of the evidence [published online ahead of print, 2020 Apr 2]. Travel Med Infect Dis 2020; 101647. doi:10.1016/j.tmaid.2020.101647

  10. Augustin M, Hallek M, Nitschmann S. Remdesivir bei Patienten mit schwerer COVID-19 [Remdesivir for patients with severe COVID-19] [published online ahead of print, 2020 Apr 24]. Internist (Berl) 2020; 1‐2. doi:10.1007/ s00108-020-00800-5

  11. Reina J. Remdesivir, la esperanza antiviral frente al SARSCoV- 2 [Remdesivir, the antiviral hope against SARS-CoV-2] [published online ahead of print, 2020 Apr 1]. Rev Esp Quimioter 2020;reina01apr2020. doi:10.37201/req/098.2020

  12. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report [published online ahead of print, 2020 May 22]. N Engl J Med 2020; 10.1056/NEJMoa2007764. doi:10.1056/NEJMoa2007764

  13. Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, et al. Should clinicians use chloroquine or hydroxychloroquine alone or in combination with azithromycin for the prophylaxis or treatment of COVID-19? [published online ahead of print, 2020 May 13]. Ann Intern Med 2020; 10.7326/M20-1998. doi:10.7326/M20-1998

  14. Geleris J, Sun Y, Platt J, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med 2020. DOI: 10.1056/NEJMoa2012410

  15. Mandeep R Mehra, Sapan S Desai, Frank Ruschitzka, Amit N Patel. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet 2020. DOI: 10.1016/ S0140-6736(20)31180-6

  16. Zhu Z, Lu Z, Xu T, et al. Arbidol monotherapy is superior to lopinavir/ritonavir in treating COVID-19 [published online ahead of print, 2020 Apr 10]. J Infect 2020; S0163- 4453(20)30188-2. doi:10.1016/j.jinf.2020.03.060

  17. Deng L, Li C, Zeng Q, et al. Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019: A retrospective cohort study [published online ahead of print, 2020 Mar 11]. J Infect 2020; S0163-4453(20)30113-4. doi:10.1016/j.jinf.2020.03.002

  18. Cao B, Wang Y, Wen D, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382: 1787-1799. DOI: 10.1056/NEJMoa2001282

  19. Stower, H. Lopinavir–ritonavir in severe COVID-19. Nat Med 2020; 26: 465. https://doi.org/10.1038/s41591- 020-0849-9

  20. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro [published online ahead of print, 2020 Apr 3]. Antiviral Res 2020; 178: 104787. doi: 10.1016/j. antiviral.2020.104787

  21. Kelleni MT. Nitazoxanide/azithromycin combination for COVID-19: A suggested new protocol for early management [published online ahead of print, 2020 Apr 30]. Pharmacol Res 2020; 157: 104874. doi: 10.1016/j.phrs.2020.104874

  22. Zhou Q, Wei X-S, Xiang X, et al. Interferon-a2b treatment for COVID-19. medRxiv 2020 Apr. 10. doi: 10.1101/2020.04.06.20042580

  23. Hung IF-N, Lung K-C, Tso EY-K, Liu R, Chung TW-H, Chu M-Y, Ng Y-Y, Lo J, Chan J, Tam AR, et al. Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an openlabel, randomised, phase 2 trial. Lancet 2020. https://doi.org/10.1016/S0140-6736(20)31042-4

  24. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020; 395(10223): 473‐475. doi: 10.1016/ S0140-6736(20)30317-2

  25. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis [published online ahead of print, 2020 Apr 10]. J Infect 2020; S0163- 4453(20)30191-2. doi: 10.1016/j.jinf.2020.03.062

  26. Iwabuchi K, Yoshie K, Kurakami Y, Takahashi K, Kato Y, Morishima T. Therapeutic potential of ciclesonide inahalation for COVID-19 pneumonia: Report of three cases. J Infect Chemother 2020; 26(6): 625‐632. doi: 10.1016/j. jiac.2020.04.007

  27. Matsuyama S, Kawase M, Nao N, et al. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. bioRxiv; 2020. DOI: 10.1101/2020.03.11.987016

  28. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA 2020; 117(20): 10970‐10975. doi:10.1073/ pnas.2005615117

  29. Buonaguro FM, Puzanov I, Ascierto PA. Anti-IL6R role in treatment of COVID-19-related ARDS. J Transl Med 2020; 18(1): 165. Published 2020 Apr 14. doi:10.1186/s12967- 020-02333-9

  30. Alattar R, Ibrahim TBH, Shaar SH, et al. Tocilizumab for the treatment of severe coronavirus disease 2019 [published online ahead of print, 2020 May 5]. J Med Virol 2020; 10.1002/jmv.25964. doi: 10.1002/jmv.25964

  31. Di Giambenedetto S, Ciccullo A, Borghetti A, et al. Off-label use of tocilizumab in patients with SARS-CoV-2 Infection [published online ahead of print, 2020 Apr 16]. J Med Virol 2020;10.1002/jmv.25897. doi: 10.1002/jmv.25897

  32. Zhang W, Zhao Y, Zhang F, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. Clin Immunol 2020; 214: 108393. doi: 10.1016/j.clim.2020.108393

  33. Elfiky AA. Anti-HCV, nucleotide inhibitors, repurposing against COVID-19. Life Sci 2020; 248: 117477. doi: 10.1016/j. lfs.2020.117477

  34. Paranjpe I, Fuster V, Lala A, Russak A, Glicksberg BS, Levin MA, Charney AW, Narula J, Fayad ZA, Bagiella E, Zhao S, Nadkarni GN, Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am College Cardiol 2020. doi: https://doi. org/10.1016/j.jacc.2020.05.001

  35. White D, MacDonald S, Bull T, et al. Heparin resistance in COVID-19 patients in the intensive care unit [published online ahead of print, 2020 May 22]. J Thromb Thrombolysis 2020; 10.1007/s11239-020-02145-0. doi: 10.1007/ s11239-020-02145-0

  36. Bikdeli B, Madhavan MV, Jimenez D, et-al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol 2020. doi: https://doi.org/10.1016/j. jacc.2020.04.031

  37. https://www.who.int/emergencies/diseases/novelcoronavirus- 2019/global-research-on-novel-coronavirus- 2019-ncov/solidarity-clinical-trial-for-covid- 19-treatments




2020     |     www.medigraphic.com