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

• Published in: PloS one 2022-01, Vol.17 (1), p.e0262608-e0262608
• Main Authors: Nasir, Noreen, Tajuddin, Salma, Khaskheli, Sarah, Khan, Naveera, Niamatullah, Hammad, Nasir, Nosheen
• Format: Article
• Language: English
• Subjects: Age; Aged; Antibiotic resistance; Antibiotics; Azithromycin; Azithromycin - therapeutic use; Biology and Life Sciences; Cardiovascular disease; Clinical outcomes; Cohort Studies; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - therapy; Creatinine; Dexamethasone; Dexamethasone - therapeutic use; Dimers; Drug therapy; FDA approval; Female; Ferritin; Health care facilities; Hospital Mortality; Hospitalization; Hospitals; Humans; Hydrocortisone; Immunomodulating Agents - therapeutic use; Immunomodulation; Immunomodulation - physiology; Male; Medicine and Health Sciences; Methylprednisolone; Methylprednisolone - therapeutic use; Middle Aged; Mortality; Pakistan - epidemiology; Patient outcomes; Patients; Polymerase chain reaction; Proteins; Regression analysis; Retrospective Studies; SARS-CoV-2 - pathogenicity; Severe acute respiratory syndrome coronavirus 2; Tertiary; Tertiary Healthcare - methods; Treatment Outcome; Values; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262608

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.