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  1. Article: Cutaneous necrosis secondary to terlipressin therapy. A rare but serious side effect. Case report and literature review.

    Iglesias Julián, Enrique / Badía Aranda, Ester / Bernad Cabredo, Belén / Corrales Cruz, Daniel / Romero Arauzo, María José

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2017  Volume 109, Issue 5, Page(s) 380–382

    Abstract: Terlipressin is a vasopressin analogue used in esophageal variceal bleeding and hepatorenal syndrome management. It is a safe drug with mild secondary effects. However, potentially serious ischemic complications may occur, such as cutaneous necrosis. It ... ...

    Abstract Terlipressin is a vasopressin analogue used in esophageal variceal bleeding and hepatorenal syndrome management. It is a safe drug with mild secondary effects. However, potentially serious ischemic complications may occur, such as cutaneous necrosis. It is useful to recognize these events early, in order to withdraw terlipressin and introduce other adjuvant drugs if needed. We report a detailed case of cutaneous necrosis secondary to terlipressin administration and present a case review of patients, describing their characteristics, risk factors, lesion locations, doses, methods of administration and possible treatments.
    Language English
    Publishing date 2017-05
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2017.4466/2016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: High dose subcutaneous Anakinra to treat acute respiratory distress syndrome secondary to cytokine storm syndrome among severely ill COVID-19 patients.

    Iglesias-Julián, Enrique / López-Veloso, María / de-la-Torre-Ferrera, Noelia / Barraza-Vengoechea, Julio Cesar / Delgado-López, Pedro David / Colazo-Burlato, María / Ubeira-Iglesias, Marta / Montero-Baladía, Miguel / Lorenzo-Martín, Andrés / Minguito-de-la-Iglesia, Javier / García-Muñoz, Juan Pablo / Sanllorente-Sebastián, Rodrigo / Vicente-González, Blanca / Alemán-Alemán, Ana / Buzón-Martín, Luis

    Journal of autoimmunity

    2020  Volume 115, Page(s) 102537

    Abstract: Objective: Severely ill COVID-19 patients may end in acute respiratory distress syndrome (ARDS) and multi-organ failure. Some of them develop a systemic hyperinflammatory state produced by the massive release of inflammatory agents, known as cytokine ... ...

    Abstract Objective: Severely ill COVID-19 patients may end in acute respiratory distress syndrome (ARDS) and multi-organ failure. Some of them develop a systemic hyperinflammatory state produced by the massive release of inflammatory agents, known as cytokine storm syndrome (CSS). Inhibition of IL-1 by Anakinra (ANK) is a potential life-saving therapy for severe CSS cases. We propose a rationale for the use of subcutaneous ANK and review our initial experience in a small cohort of severe COVID-19 CSS patients.
    Methods: Retrospective cohort study of COVID-19 patients developing ARDS (PaO2/FiO2 <300) and exhibiting signs of hyperinflammation (ferritin >1000 ng/mL and/or d-dimers > 1.5 μg/mL, plus IL-6 < 40 mg/mL) that received ANK. For comparison, a propensity score matched historical cohort of patients treated with IL-6 inhibitor Tocilizumab (TCZ) was used. Patients had previously received combinations of azithromycin, hydroxy-chloroquine, and methyl-prednisolone. Laboratory findings, respiratory function and adverse effects were monitored. Resolution of ARDS within the first 7 days of treatment was considered a favorable outcome.
    Results: Subcutaneous ANK (100 mg every 6 h) was given to 9 COVID-19 ARDS CSS patients (77.8% males). Median age was 62 years (range, 42 to 87). A TCZ cohort of 18 patients was selected by propensity score matching and treated with intravenous single dose of 600 mg for patients weighing >75 Kg, or 400 mg if < 75 Kg. Prior to treatment, median PaO2/FiO2 ratio of the ANK and TCZ cohorts were 193 and 249, respectively (p = 0.131). After 7 days of treatment, PaO2/FiO2 ratio improved in both groups to 279 (104-335) and 331 (140-476, p = 0.099) respectively. On day 7, there was significant reduction of ferritin (p = 0.046), CRP (p = 0.043), and IL-6 (p = 0.043) levels in the ANK cohort but only of CRP (p = 0.001) in the TCZ group. Favorable outcome was achieved in 55.6% and 88.9% of the ANK and TCZ cohorts, respectively (p = 0.281). Two patients that failed to respond to TCZ improved after ANK treatment. Aminotransferase levels significantly increased between day 1 and day 7 (p = 0.004) in the TCZ group. Mortality was the same in both groups (11%). There were not any opportunistic infection in the groups nor other adverse effects attributable to treatment.
    Conclusion: Overall, 55.6% of COVID-19 ARDS CSS patients treated with ANK exhibited favorable outcome, not inferior to a TCZ treated matched cohort. ANK may be a potential alternative to TCZ for patients with elevated aminotransferases, and may be useful in non-responders to TCZ.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/therapeutic use ; Cohort Studies ; Cytokine Release Syndrome/drug therapy ; Disease Progression ; Female ; Humans ; Injections, Subcutaneous ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Interleukin-1/antagonists & inhibitors ; Interleukin-6/antagonists & inhibitors ; Male ; Middle Aged ; Respiratory Distress Syndrome/drug therapy ; SARS-CoV-2/physiology ; Spain ; COVID-19 Drug Treatment
    Chemical Substances Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1 ; Interleukin-6 ; tocilizumab (I031V2H011)
    Keywords covid19
    Language English
    Publishing date 2020-08-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 639452-8
    ISSN 1095-9157 ; 0896-8411
    ISSN (online) 1095-9157
    ISSN 0896-8411
    DOI 10.1016/j.jaut.2020.102537
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    Zs.A 2368: Show issues Location:
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  3. Article: High dose subcutaneous Anakinra to treat acute respiratory distress syndrome secondary to cytokine storm syndrome among severely ill COVID-19 patients

    Iglesias-Julián, Enrique / López-Veloso, María / de-la-Torre-Ferrera, Noelia / Barraza-Vengoechea, Julio Cesar / Delgado-López, Pedro David / Colazo-Burlato, María / Ubeira-Iglesias, Marta / Montero-Baladía, Miguel / Lorenzo-Martín, Andrés / Minguito-de-la-Iglesia, Javier / García-Muñoz, Juan Pablo / Sanllorente-Sebastián, Rodrigo / Vicente-González, Blanca / Alemán-Alemán, Ana / Buzón-Martín, Luis

    J Autoimmun

    Abstract: OBJECTIVE: Severely ill COVID-19 patients may end in acute respiratory distress syndrome (ARDS) and multi-organ failure. Some of them develop a systemic hyperinflammatory state produced by the massive release of inflammatory agents, known as cytokine ... ...

    Abstract OBJECTIVE: Severely ill COVID-19 patients may end in acute respiratory distress syndrome (ARDS) and multi-organ failure. Some of them develop a systemic hyperinflammatory state produced by the massive release of inflammatory agents, known as cytokine storm syndrome (CSS). Inhibition of IL-1 by Anakinra (ANK) is a potential life-saving therapy for severe CSS cases. We propose a rationale for the use of subcutaneous ANK and review our initial experience in a small cohort of severe COVID-19 CSS patients. METHODS: Retrospective cohort study of COVID-19 patients developing ARDS (PaO2/FiO2 <300) and exhibiting signs of hyperinflammation (ferritin >1000 ng/mL and/or d-dimers > 1.5 µg/mL, plus IL-6 < 40 mg/mL) that received ANK. For comparison, a propensity score matched historical cohort of patients treated with IL-6 inhibitor Tocilizumab (TCZ) was used. Patients had previously received combinations of azithromycin, hydroxy-chloroquine, and methyl-prednisolone. Laboratory findings, respiratory function and adverse effects were monitored. Resolution of ARDS within the first 7 days of treatment was considered a favorable outcome. RESULTS: Subcutaneous ANK (100 mg every 6 h) was given to 9 COVID-19 ARDS CSS patients (77.8% males). Median age was 62 years (range, 42 to 87). A TCZ cohort of 18 patients was selected by propensity score matching and treated with intravenous single dose of 600 mg for patients weighing >75 Kg, or 400 mg if < 75 Kg. Prior to treatment, median PaO2/FiO2 ratio of the ANK and TCZ cohorts were 193 and 249, respectively (p = 0.131). After 7 days of treatment, PaO2/FiO2 ratio improved in both groups to 279 (104-335) and 331 (140-476, p = 0.099) respectively. On day 7, there was significant reduction of ferritin (p = 0.046), CRP (p = 0.043), and IL-6 (p = 0.043) levels in the ANK cohort but only of CRP (p = 0.001) in the TCZ group. Favorable outcome was achieved in 55.6% and 88.9% of the ANK and TCZ cohorts, respectively (p = 0.281). Two patients that failed to respond to TCZ improved after ANK treatment. Aminotransferase levels significantly increased between day 1 and day 7 (p = 0.004) in the TCZ group. Mortality was the same in both groups (11%). There were not any opportunistic infection in the groups nor other adverse effects attributable to treatment. CONCLUSION: Overall, 55.6% of COVID-19 ARDS CSS patients treated with ANK exhibited favorable outcome, not inferior to a TCZ treated matched cohort. ANK may be a potential alternative to TCZ for patients with elevated aminotransferases, and may be useful in non-responders to TCZ.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #722639
    Database COVID19

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  4. Article ; Online: High dose subcutaneous Anakinra to treat acute respiratory distress syndrome secondary to cytokine storm syndrome among severely ill COVID-19 patients

    Iglesias-Julián, Enrique / López-Veloso, María / de-la-Torre-Ferrera, Noelia / Barraza-Vengoechea, Julio Cesar / Delgado-López, Pedro David / Colazo-Burlato, María / Ubeira-Iglesias, Marta / Montero-Baladía, Miguel / Lorenzo-Martín, Andrés / Minguito-de-la-Iglesia, Javier / García-Muñoz, Juan Pablo / Sanllorente-Sebastián, Rodrigo / Vicente-González, Blanca / Alemán-Alemán, Ana / Buzón-Martín, Luis

    Journal of Autoimmunity

    2020  , Page(s) 102537

    Keywords Immunology ; Immunology and Allergy ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 639452-8
    ISSN 0896-8411
    ISSN 0896-8411
    DOI 10.1016/j.jaut.2020.102537
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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