COVID-19: OUR FIRST TREATMENT EXPERIENCES

Cilj: Iznenadna pojava epidemije koronavirusne bolesti 2019 (COVID-19) uzrokovane koronavirusom 2 teškog akutnog respiratornog sindroma (SARS-CoV-2) zatekla je zdravstvene sustave širom svijeta potpuno nespremne, i svi terapijski pokušaji liječenja bolesti danas su još uvijek na razini kliničkih ispitivanja ili empirijskih terapija, pa su i terapijski ishodi različiti. Među lijekove koji se danas koriste u brojnim randomiziranim kliničkim studijama spadaju i klorokin, jedan stari antimalarik, i tocilizumab, prvi blokator interleukina-6 na tržištu. Cilj ovoga rada bio je prikazati naša prva iskustva u terapiji COVID-19 infekcije s tim lijekovima. Metode: U razdoblju od 10. 3.- 9. 5. 2020. u zadarskoj županiji registrirano je 85 osoba s pozitivnim nalazom na SARS-Cov-2 koronavirus metodom polimerazne lančane reakcije u realnom vremenu (RT-PCR) od kojih je 31 (36,5 %) hospitalizirano. U 27 (87,1 %) bolesnika kao početna terapija primijenjen je klorokin, a u 3 (9,6 %) kombinacija lopinavir/ritonavir. Rezultati: 5 bolesnika (16,1 %) iz skupine liječenih klorokinom premješteno je u JIL zbog progresije bolesti i potrebe za mehaničkom ventilacijom, a troje (9,6 %) od njih liječeni su tocilizumabom, s dobrim terapijskim ishodom u svih. Zaključak: Rezultati liječenja naših bolesnika upućuju na potrebu ranog uključivanja klorokina u terapijski protokol COVID-19 infekcije, ali i ranijeg uključivanja tocilizumaba u terapiju teških bolesnika, kako bi se spriječila progresija bolesti.Background: The sudden outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fi nds healthcare systems worldwide completely unprepared and all the attempts at treatment remain at the level of clinical investigations or empiric treatments, and therefore there are different treatment outcomes. Chloroquine, an old antimalarial drug and tocilizumab, the fi rst marketed interleukin-6 blocking antibody belong to the drugs that are in use in numerous randomized clinical trials today. The aim of this report is to present our fi rst experiences with these drugs in the treatment of COVID-19 infection. Methods: In the period from March 10 to May 9, 2020, 85 individuals with real-time polymerase chain reaction (RT-PCR) positive fi ndings of SARS-CoV-2 coronavirus were registered in the Zadar County; 31 (36.5%) of them were hospitalized. Chloroquine was the initial treatment in 27 (87.1%) and a combination of lopinavir/ritonavir in three (9.6%) subjects. Results: Five (16.1%) patients of those treated with chloroquine were admitted to the intensive care unit because of progressive course of the disease and need for mechanical ventilation, while another three (9.6%) patients received tocilizumab, with good clinical outcome. Conclusion: Our results suggest the need for early inclusion of chloroquine in the treatment protocol for COVID-19 infection, and tocilizumab in the cases of severe form of the infection to prevent the disease progression