DOI: https://doi.org/10.14710/jai.v12i3.32905

Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

1Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Lambung Mangkurat/RSUD Ulin, Banjarmasin, Indonesia

2Departemen Pulmonologi dan Kedokteran Respirasi, Fakultas Kedokteran, Universitas Lambung Mangkurat/RSUD Ulin, Banjarmasin, Indonesia

Published: 1 Nov 2020.
Open Access Copyright 2020 JAI (Jurnal Anestesiologi Indonesia)

Citation Format:
Abstract

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.

Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.

Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.

Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

Fulltext View|Download
Keywords: badai sitokin; COVID-19; ICU; interleukin-6; tocilizumab

Article Metrics:

Article Info
Section: Case Reports
Language : ID
Recent articles
Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19 Penggunaan Heparin Dosis Tinggi pada Pasien COVID-19 dengan ARDS dan Hipertensi di Unit Perawatan Intensif (ICU) Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid More recent articles
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. World Health Organization. WHO Coronavirus Diseases (COVID-19) Dashboard [Internet]. 2020 [cited 2020 Sep 12]. Available from: https://covid19.who.int/
  2. COVID-19 GTPP. Situasi Virus COVID-19 di Indonesia [Internet]. 2020 [cited 2020 Sep 12]. Available from: https://covid19.go.id/
  3. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. Vol. 323, JAMA - Journal of the American Medical Association. 2020. p. 1239–42
  4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506
  5. Betts BC, Young JW. Less Can Be More When Targeting Interleukin-6-Mediated Cytokine Release Syndrome in Coronavirus Disease 2019. Crit Care Explor. 2020;2(6):e0138
  6. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620–9
  7. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev. 2020;7(6):998–1002
  8. Wang L, Peng X, Wang ZH, Cai J, Zhou FC. Tocilizumab in the treatment of a critical COVID-19 patient: A case report. Eur Rev Med Pharmacol Sci. 2020;24(10):5783–7
  9. Hitawala A, Kumar S, Gopalakrishna K V. Early Use of Tocilizumab May Prevent Clinical Deterioration in Select COVID-19 Patients: A Case Series. Cureus. 2020;12(7)
  10. Scott LJ. Tocilizumab: A Review in Rheumatoid Arthritis. Drugs. 2017;77(17):1865–79
  11. Tadepalli S, Vanjarapu JMR, De Dona A, Cheriyath P, Nookala V. The Role of Interleukin-6 Inhibitors in the Treatment of COVID-19 Infections: A Case Series. Cureus. 2020;12(6)
  12. Atal S, Fatima Z. IL-6 Inhibitors in the Treatment of Serious COVID-19: A Promising Therapy? Pharmaceut Med. 2020;(0123456789)
  13. Liu Z, Li J, Chen D, Gao R, Zeng W, Chen S, et al. Dynamic Interleukin-6 Level Changes as a Prognostic Indicator in Patients With COVID-19. Front Pharmacol. 2020;11(July):1–11
  14. KEMENKES. Peta Sebaran COVID-19 di Indonesia [Internet]. 2020 [cited 2020 Sep 12]. Available from: https://covid19.go.id/peta-sebaran
  15. Quah P, Li A, Phua J, Phua J. Mortality rates of patients with COVID-19 in the intensive care unit: A systematic review of the emerging literature. Crit Care. 2020;24(1):1–4
  16. Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117(20):10970–5
  17. BUMN, Pertamina, Indonesia Healthcare Corporation. Buku Pegangan Pencegahan & Penatalaksanaan COVID-19. Revisi-1. Jakarta; 2020
  18. Yoshikawa T, Hill T, Li K, Peters CJ, Tseng C-TK. Severe Acute Respiratory Syndrome (SARS) Coronavirus-Induced Lung Epithelial Cytokines Exacerbate SARS Pathogenesis by Modulating Intrinsic Functions of Monocyte-Derived Macrophages and Dendritic Cells. J Virol. 2009;83(7):3039–48
  19. Herold T, Jurinovic V, Arnreich C, Lipworth BJ, Hellmuth JC, Bergwelt-Baildon M von, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol [Internet]. 2020;146(1):128-136.e4. Available from: https://doi.org/10.1016/j.jaci.2020.05.008
  20. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62
  21. Sciascia S, Aprà F, Baffa A, Baldovino S, Boaro D, Boero R, et al. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol. 2020;38(3):529–32
  22. Gong J, Dong H, Xia SQ, Huang YZ, Wang D, Zhao Y, et al. Correlation Analysis Between Disease Severity and Inflammation-related Parameters in Patients with COVID-19 Pneumonia. 2020;
  23. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762–8
  24. Liu F, Li L, Xu M Da, Wu J, Luo D, Zhu YS, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020;127
  25. Kermali M, Khalsa RK, Pillai K, Ismail Z, Harky A. The role of biomarkers in diagnosis of COVID-19 – A systematic review. Vol. 254, Life Sciences. 2020
  26. Hajra A, Mathai SV, Ball S, Bandyopadhyay D, Veyseh M, Chakraborty S, et al. Management of Thrombotic Complications in COVID-19: An Update. Drugs [Internet]. 2020;(0123456789). Available from: https://doi.org/10.1007/s40265-020-01377-x
  27. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324–9
  28. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1–14
  29. Han Y, Zhang H, Mu S, Wei W, Jin C, Tong C, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: A retrospective and observational study. Aging (Albany NY). 2020;12(12):11245–58
  30. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20
  31. Calabrese C, Rajendram P, Sacha G, Calabrese L. Practical aspects of targeting IL-6 in COVID-19 disease: Posted april 21, 2020. Cleve Clin J Med. 2020;87(5):1–5

Last update:

No citation recorded.

Last update: 2024-12-21 03:30:17

No citation recorded.