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ERTÜRK ŞENGEL, BUKET

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ERTÜRK ŞENGEL

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2021 - 20222
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Author: ODABAŞI, ZEKAVER × Subject: COVID-19 ×

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    PublicationOpen Access
    Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls
    (SPRINGER HEIDELBERG, 2022-03) ERTÜRK ŞENGEL, BUKET; Mert, Ali; Vahaboglu, Haluk; Arslan, Ferhat; Batirel, Ayse; Saracoglu, Kemal Tolga; Bastug, Aliye; Cagatay, Atahan; Irmak, Ilim; Dizman, Gulcin Telli; Ertenli, Ihsan; Altunal, Lutfiye Nilsun; Sengel, Buket Erturk; Bayram, Mehmet; Omma, Ahmet; Amikishiyev, Shirkhan; Aypak, Adalet; Bes, Cemal; Bolukcu, Sibel; Icten, Sacit; Topeli, Arzu; Bektas, Murat; Arslan, Birsen Yigit; Ozturk, Sinan; Comoglu, Senol; Aydin, Selda; Kucuksahin, Orhan; Icacan, Ozan Cemal; Ince, Burak; Aghamuradov, Sarvan; Mutlu, Melek Yalcin; Simsek, Funda; Emre, Salih; Ustun, Cemal; Ergen, Pinar; Aydin, Ozlem; Koc, Meliha Meric; Sevindik, Omur Gokmen; Odabasi, Zekaver; Korten, Volkan; Bodur, Hurrem; Guner, Rahmet; Unal, Serhat; Kocak, Mehmet; Gul, Ahmet
    Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.
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    PublicationOpen Access
    Impact of tocilizumab on clinical outcomes in severe COVID-19 patients and risk of secondary infection: A case-control study
    (MARMARA UNIV, FAC MEDICINE, 2021-05-25) ERTÜRK ŞENGEL, BUKET; Sengel, Buket Erturk; Ozel, Serra; Gul, Fethi; Ilgin, Can; Tigen, Elif Tukenmez; Altunal, Luftiye Nilsun; Kabadayi, Feyyaz; Sili, Uluhan; Aydin, Mehtap; Odabasi, Zekaver; Cinel, Ismail; Korten, Volkan
    Objective: This study aimed to identify the effect of tocilizumab (TCZ) on clinical outcomes in severe COVID-19 patients. Material and Methods: We included hospitalized COVID-19 patients with an initial WHO scale >= 4. We matched the patients with baseline characteristics by using propensity scores. Then, we selected patients with C-reactive protein levels above 30 and showing an upward trend. We assessed the effect of TCZ in patients on clinical outcomes by using Mann - Whitney U and Chi-square tests. Results: Of 200 patients who had an initial WHO scale >= 4, 42 (21%) were given it? in addition to standard of care (SOC). Twenty-five patients (50%) needed mechanical ventilation (MV) in the TCZ group, compared with 35 (21%) of 158 patients with SOC (p<0.01). Nineteen (45%) and 37 (23%) patients died in 30 days in these groups, respectively (p <0.01). The secondary infection rate was significantly higher in the TCZ group (p=0.004). However, no difference was observed in all these parameters in the propensity score-matched cohort (14 patients in ICZ and 14 in the SOC group) (p=0.45, 0.45, 1.0 respectively). Conclusions: Tocilizumab does not provide a beneficial effect on MV requirement and mortality in severe COVID-19, and it does not increase the risk of secondary bacterial infection.