2026-04-13T02:55:08Zhttps://recercat.cat/oai/request

oai:recercat.cat:2445/1790822025-12-05T13:16:14Zcom_2072_1057col_2072_478798col_2072_478916col_2072_478917col_2072_478929

00925njm 22002777a 4500 dc Solanich, Xavier author Antolí, Arnau author Rocamora Blanch, Gemma author Padullés Zamora, Núria author Fanlo Maresma, Marta author Iriarte, Adriana author Mitjavila Villeró, Francesca author Capdevila, Olga author Riera Mestre, Antoni author Bas, Jordi author Vicens Zygmunt, Vanesa author Niubó, Jordi author Calvo, Nahum author Bolivar, Santiago author Rigo Bonnin, Raúl author Mensa Vilaró, Anna author Arregui, Laura author Tebé, Cristian author Videla, Sebastià author Hereu, Pilar author Corbella, Xavier author 2021-07-15T08:34:07Z 2021-07-15T08:34:07Z 2021-06-14 2021-07-15T08:03:13Z Introduction: Severe lung injury is triggered by both the SARS-CoV-2 infection and the subsequent host-immune response in some COVID-19 patients. Methods: We conducted a randomized, single-center, open-label, phase II trial with the aim to evaluate the efficacy and safety of methylprednisolone pulses and tacrolimus plus standard of care (SoC) vs. SoC alone, in hospitalized patients with severe COVID-19. The primary outcome was time to clinical stability within 56 days after randomization. Results: From April 1 to May 2, 2020, 55 patients were prospectively included for subsequent randomization; 27 were assigned to the experimental group and 28 to the control group. The experimental treatment was not associated with a difference in time to clinical stability (hazard ratio 0.73 [95% CI 0.39-1.37]) nor most secondary outcomes. Median methylprednisolone cumulative doses were significantly lower (360 mg [IQR 360-842] vs. 870 mg [IQR 364-1451]; p = 0.007), and administered for a shorter time (median of 4.00 days [3.00-17.5] vs. 18.5 days [3.00-53.2]; p = 0.011) in the experimental group than in the control group. Although not statistically significant, those receiving the experimental therapy showed a numerically lower all-cause mortality than those receiving SoC, especially at day 10 [2 (7.41%) vs. 5 (17.9%); OR 0.39 (95% CI 0.05-2.1); p = 0.282]. The total number of non-serious adverse events was 42 in each the two groups. Those receiving experimental treatment had a numerically higher rate of non-serious infectious adverse events [16 (38%) vs. 10 (24%)] and serious infectious adverse events [7 (35%) vs. 3 (23%)] than those receiving SoC. Conclusions: The combined use of methylprednisolone pulses plus tacrolimus, in addition to the SoC, did not significantly improve the time to clinical stability or other secondary outcomes compared with the SoC alone in severe COVID-19. Although not statistically significant, patients receiving the experimental therapy had numerically lower all-cause mortality than those receiving SoC, supporting recent non-randomized studies with calcineurin inhibitors. It is noteworthy that the present trial had a limited sample size and several other limitations. Therefore, further RCTs should be done to assess the efficacy and safety of tacrolimus to tackle the inflammatory stages of COVID-19. COVID-19 Assaigs clínics COVID-19 Clinical trials Methylprednisolone Pulses Plus Tacrolimus in Addition to Standard of Care vs. Standard of Care Alone in Patients With Severe COVID-19. A Randomized Controlled Trial