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ICYMI: COVID-19 and Thrombotic Complications
Severe and fatal outcomes with coronavirus infection are often the result of the downstream damage that follows the viral infection. Rising high on the list of complications are the hematologic and vascular complications seen in severely affected patients, so much so that many centers are routinely anticoagulating hospitalized (but not ambulatory) COVID patients.
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ICYMI: The Nine Lives of Hydroxychloroquine (Updated)
Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.
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ICYMI: Outcomes of Critically-Ill COVID Patients in NYC
Lancet has reported COVID outcomes from NewYork-Presbyterian hospitals in NYC during March 2020 showing high rates of hospitalization, ICU admission, mechanical ventilation and death.
A prospective observational cohort study 2 2 NYC hospitals from March 2 to April 1, 2020, looking at laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was in-hospital death.
COVID's Multisystem Inflammatory Syndrome in Children
Two recent reports further characterize the newly described, Kawasaki-like, syndrome affecting children with COVID-19 infections.
The NEJM describes the childhood syndrome as having Kawasaki’s disease, fever, toxic shock syndrome, acute abdominal conditions, and encephalopathy; hence the label Childhood Multisystem Inflammatory Syndrome. The disorder emerged in late April 2020, first in the U.K., and then similar cases were reported from many other countries. The CDC named this multisystem inflammatory syndrome in children (MIS-C).
Tocilizumab May Benefit COVID-19 Pneumonia
A retrospective, observational study published in Lancet Rheumatology has shown that tocilizumab (TCZ) may reduce the risk of death or the need for mechanical ventilation in severe COVID-19 pneumonia. This observational study included adults, with severe COVID-19 pneumonia, who were hospitalized between Feb 21 and March 24, 2020. All were on the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received TCZ.
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RheumNow Podcast – Lupus Mortality Declines, But… (6.26.20)
Dr Jack Cush reviews the news and journal articles from the past week on RheumNow.com
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Protective Benefit of Colchicine in COVID-19 Infection
Colchicine has been advocated as a potential anti-inflammatory intervention in patients with the coronavirus 2 infection and clinical trials have been developed to assess its effect in early COVID-2 infection. JAMA has published a randomized clinical trial showing that low dose colchicine had less clinical deterioration without significant changes in biomarkers, such as high-sensitivity cardiac troponin and C-reactive protein.
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Hydroxychloroquine Fails as Postexposure Prophylaxis for Covid-19
Add this to the list of hydroxychloroquine (HCQ) letdowns in managing COVID-19 treatment or risk - prophylaxis with HCQ fails to prevent COVID-19 infection in those exposed to the SARS-CoV-2 virus.
NEJM has reported a prospective, randomized, double-blind, placebo-controlled trial from the US and Canada wherein adults with household or occupational exposure to someone with confirmed Covid-19 were treated with either placebo or HCQ within 4 days of exposure.
Upside Down with Tocilizumab in COVID-19
Several recent reports offer conflicting views on the potential benefits and adverse outcomes of IL-6 inhibition with tocilizumab (TCZ) therapy in patients with severe COVID-19 infection.
An Italian study grabbed the headlines yesterday with a press release stating TCZ did not improve respiratory symptoms, ICU admissions or mortality rates when given to 126 COVID patients with early disease. The study, supported by the Italian Medicines Agency (Aifa), stopped enrollment (about 1/3 of projections) after an interim analysis found insufficient evidence that TCZ would be effective. This report has not been published or undergone critical review.
RheumNow Podcast – Enough Already with Weaning (6.19.20)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com.
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Dexamethasone Reduces Mortality in Severe COVID
Preliminary results released today shows dexamethasone (DEX), given to hospitalized, severly ill, COVID-19 patients, is capable of reducing mortality rates by one-third, with researchers calling this a “major breakthrough” in coronavirus management.
The results stem from a UK trial, called the RECOVERY trial, launched in March 2020, compared outcomes of around 2100 patients who were randomly assigned to DEX treatment compared with 4,300 patients not on DEX.
Preventing COVID - Masks, Meters and Eyewear
A Lancet systematic review and meta-analysis provides the basis for physical distancing and the value of making as measures to prevent infection with coronavirus 2 (SARS-CoV-2) or COVID-19.
The analysis included 172 observational studies, no randomised controlled trials and 44 relevant comparative studies involving 25 697 patients.
Hydroxychloroquine Postexposure Prophylaxis for COVID-19 Fails
NEJM has reported that the use of hydroxychloroquine did not prevent symptomatic COVID-19 infection when used within 4 days after SARS-CoV-2 exposure.
Currently for persons who are COVID exposed, the standard of care is quarantine and there is no known preventative therapy.
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RheumNow Podcast - Rheumatic Patients with COVID (5.29.20)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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TNR Grand Rounds - Cytokine Storm Syndromes
This week's Tuesday Nite Rheumatology featured Dr Randy Cron from the University of Alabama - Birmingham as he spoke and took questions on the immunology, immunopathogenesis and treatment of Cytokine Storm Syndrome, especially as they relate to COVID-19 and rheumatic disease patients. The program was moderated by Dr. Jack Cush.
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Boston and Wuhan Report Rheum COVID Patients at Risk for Respiratory Failure
Two current reports from Boston and Wuhan describe cohorts of COVID-19 (+) rheumatic disease patients who generally do well but appear to have a higher risk of pulmonary involvement.
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Low Risk of COVID-19 Pneumonia in Rheumatic Patients
A current letter in the Annals of Rheumatic Disease details the rheumatic disease patient cohort outcomes from the University of Siena, Italy showing only 2 cases of COVID-19 among 859 patients treated with tsDMARDs and bDMARDs.
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Again, Antimalarial Use Fails to Benefit COVID
Today Lancet reported the results of another retrospective trial showing that hydroxychloroquine or chloroquine, alone or with a macrolide antibioitic, offered no additional benefits to COVID-19 patients, but was associated with higher rates of mortality and arrhythmia.
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Outcomes of Critically-Ill COVID Patients in NYC
Lancet has reported COVID outcomes from NewYork-Presbyterian hospitals in NYC during March 2020 showing high rates of hospitalization, ICU admission, mechanical ventilation and death.
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