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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.
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