Comparative efficacy of tocilizumab and baricitinib in COVID-19 treatment: a retrospective cohort study

Background Although the biological agents tocilizumab and baricitinib have been shown to improve the outcomes of patients with COVID-19, a comparative evaluation has not been performed. The aim of our study was to evaluate the comparative effect of the use of tocilizumab and baricitinib on patient outcomes in COVID-19. Methods A retrospective, single-center study was conducted using the data of patients with COVID-19 admitted to Hokkaido University hospital between April 2020 and September 2021 and were treated with tocilizumab or baricitinib. The clinical characteristics of the patients who received each drug were compared. Univariate and multivariate logistic regression analyses were performed against the outcomes of all-cause mortality and the improvement in respiratory status. The development of secondary infection events was analyzed using the Kaplan–Meier method and the log-rank test. Results Among the 459 patients hospitalized with COVID-19 during the study, 64 received tocilizumab and 34 received baricitinib, and they were included in the study. Most patients were treated with concomitant steroids, and the severity of the disease at the time of initiation of biological agents was similar. The use of tocilizumab or baricitinib was not associated with all-cause mortality or the improvement in respiratory status within 28 days of drug administration. Age, chronic renal disease, and comorbid respiratory disease were independent prognostic factors for all-cause mortality, whereas anti-viral drug use and severity of COVID-19 at baseline were associated with the improvement in respiratory status. There was no significant difference in the infection-free survival rate between patients treated with tocilizumab and those with baricitinib. Conclusion There were no differences in efficacy and safety between tocilizumab and baricitinib in the treatment of COVID-19. Both these biological agents are expected to be equally safe and clinically effective.

Comparative efficacy of tocilizumab and baricitinib in COVID-19 treatment: a retrospective cohort study

SummaryBackgroundAlthough biological agents, tocilizumab and baricitinib, have been shown to improve the outcomes of patients with COVID-19, a comparative evaluation has not been performed.MethodsA retrospective, single-center study was conducted using the data of patients with COVID-19 admitted to the Hokkaido University hospital between April 2020 and September 2021, who were treated with tocilizumab or baricitinib. The clinical characteristics of patients who received each drug were compared. Univariate and multivariate logistic regression models were performed against the outcomes of all-cause mortality and the improvement in respiratory status. The development of secondary infection events was analyzed using the Kaplan–Meier analysis and the log-rank test.ResultsThe use of tocilizumab or baricitinib was not associated with all-cause mortality and the improvement in respiratory status within 28 days of drug administration. Age, chronic renal disease, and comorbid respiratory disease were independent prognostic factors for all-cause mortality, while anti-viral drug use and severity of COVID-19 at baseline were associated with the improvement in respiratory status. There was no significant difference in the infection-free survival between patients treated with tocilizumab and those with baricitinib.ConclusionThere were no differences in efficacy and safety between tocilizumab and baricitinib for the treatment of COVID-19.

Emerging Insights Into Chronic Renal Disease Pathogenesis in Hypertension From Human and Animal Genomic Studies

The pathogenic links between elevated blood pressure and chronic kidney disease remain obscure. This article examines progress in population genetics and in animal models of hypertension and chronic kidney disease. It also provides a critique of the application of genome-wide association studies to understanding the heritability of renal function. Emerging themes identified indicate that heritable risk of chronic kidney disease in hypertension can arise from genetic variation in (1) glomerular and tubular protein handling mechanisms; (2) autoregulatory capacity of the renal vasculature; and (3) innate and adaptive immune mechanisms. Increased prevalence of hypertension-associated chronic kidney disease that occurs with aging may reflect amplification of heritable risks by normal aging processes affecting immunity and autoregulation.

Vitamin D Deficiency in Children with Chronic Renal Disease

BACKGROUND: Vitamin D is essential for children and adults for healthy bone growth. Lack of this vitamin in children can cause rickets, and in adults, softening of the bones and an increased risk of fractures. Vitamin D deficiency can cause immune disorders, increased susceptibility to infections, the development of certain types of cancer, diabetes mellitus, and cardiovascular diseases. AIM: The article presents the literature data and the results of our own research on the analysis of the relationship between chronic kidney disease (CKD) and Vitamin D provision in children from 1 to 17 years old. The aim of the study was to establish the level of Vitamin D in children with different stages of CKD. METHODS: Between January 2020 and September 2020, we examined 40 children (16 boys and 24 girls). The patients’ age ranged from 1 to 17 years inclusive. RESULTS: Vitamin D deficiency was found in 62.5% of children with CKD. Vitamin D deficiency was noted in 25% of cases. The prevalence of Vitamin D deficiency correlates with a decrease in glomerular filtration rate. CONCLUSION: Determination of Vitamin D level in children with CKD is important for timely correction and prevention of further progression of CKD. Timely substitution therapy will improve the quality of life of a child with CKD and prevent the development of complications.

Dietary calcium to phosphorus ratio affects postprandial phosphorus concentrations in feline plasma

The impact of dietary phosphorus on chronic renal disease in cats, humans and other species is receiving increasing attention. As calcium (Ca) and phosphorus (P) metabolism are linked, the ratio of Ca:P is an important factor for consideration when formulating diets for cats and other animals. Here, we describe a fully randomized crossover study including 24 healthy, neutered adult cats, investigating post-prandial responses in plasma P, ionised Ca (iCa) and parathyroid hormone (PTH) following one meal (50% of individual metabolic energy requirement) of each of six experimental diets. Diets were formulated to provide P at either 0.75 or 1.5 g/1000kcal (4184kJ) from the soluble phosphorus salt sodium tripolyphosphate (STPP, Na5P3O10), variable levels of organic Ca and P sources, and an intended total Ca:P of ∼1.0, 1.5 or 2.0. For each experimental diet, baseline fasted blood samples were collected prior to the meal, and serial blood samples collected hourly for 6 hours thereafter. For all diets, a significant increase from baseline was observed at 120mins in plasma PTH (p<0.001). The diet containing the highest STPP inclusion level and lowest Ca:P induced the highest peaks in post-prandial plasma P and PTH levels (1.8mmol/l and 27.2pg/ml, respectively) and the longest duration of concentrations raised above baseline were observed at 3 hours for P and 6 hours for PTH. Data indicate that Ca:P modulates postprandial plasma P and PTH. Therefore, when formulating diets containing soluble P salts for cats, increasing the Ca:P ratio should be considered.

Clinical Features and Laboratory Examination to Identify Severe Patients with COVID-19: A Systematic Review and Meta-Analysis

Background. With the COVID-19 epidemic breakout in China, up to 25% of diagnosed cases are considered to be severe. To effectively predict the progression of COVID-19 via patients’ clinical features at an early stage, the prevalence of these clinical factors and their relationships with severe illness were assessed. Methods. In this study, electronic databases (PubMed, Embase, Web of Science, and Chinese database) were searched to obtain relevant studies, including information on severe patients. Publication bias analysis, sensitivity analysis, prevalence, sensitivity, specificity, likelihood ratio, diagnosis odds ratio calculation, and visualization graphics were achieved through software Review Manager 5.3, Stata 15, Meta-DiSc 1.4, and R. Results. Data of 3.547 patients from 24 studies were included in this study. The results revealed that patients with chronic respiratory system diseases (pooled positive likelihood 6.07, 95% CI: 3.12-11.82), chronic renal disease (4.79, 2.04-11.25), cardiovascular disease (3.45, 2.19-5.44), and symptoms of the onset of chest tightness (3.8, 1.44-10.05), shortness of breath (3.18, 2.24-4.51), and diarrhea (2.04, 1.38-3.04) exhibited increased probability of progressing to severe illness. C-reactive protein, ratio of neutrophils to lymphocytes, and erythrocyte sedimentation rate increased a lot in severe patients compared to nonsevere. Yet, it was found that clinical features including fever, cough, and headache, as well as some comorbidities, have little warning value. Conclusions. The clinical features and laboratory examination could be used to estimate the process of infection in COVID-19 patients. The findings contribute to the more efficient prediction of serious illness for patients with COVID-19 to reduce mortality.

Tuberculosis and COVID-19 co-infection: description of the global cohort

Information on tuberculosis (TB) and COVID-19 is still limited. The aim of this study is to describe the features of the TB/COVID-19 co-infected individuals from a prospective, anonymised, multi-country register-based cohort with special focus on the determinants of mortality and other outcomes. We enrolled all patients of any age with either active TB or previous TB and COVID-19. 172 centres from 34 countries provided individual data on 767 TB-COVID-19 co-infected patients, (>50% population-based). Of 767 patients, 553/747 (74.0%) had TB before COVID-19 (including 234/747 with previous TB), 71/747 (9.5%) had COVID-19 first and 123/747 (16.5%) had both diseases diagnosed within the same week (35, 4.6% on the same day). 85/767 patients died (11.08%) (41/289 (14.2%) in Europe and 44/478 (9.2%) outside Europe; (p=0.03)): 42 (49.4%) from COVID-19, 31 (36.5%) from COVID-19 and TB, 1/85 (1.2%) from TB and 11 from other causes. In the univariate analysis on mortality the following variables reached statistical significance: age, being male, having >1 comorbidity; diabetes mellitus, cardiovascular disease, chronic respiratory disease, chronic renal disease, presence of key symptoms, invasive ventilation and hospitalisation due to COVID-19. The final multivariable logistic regression model included age, male gender, and invasive ventilation as independent contributors to mortality. The data suggests TB and COVID-19 are a “cursed duet” and need immediate attention. TB should be considered a risk factor for severe COVID disease and patients with TB should be prioritised for COVID-19 preventative efforts, including vaccination.