Cyclosporine A therapy in patients with COVID-19 and failure of immunosuppression therapy: a retrospective cohort propensity-score matched analysis

Abstract

INTRODUCTION: Therapy of COVID-19 patients with progressive lung damage after the use of glucocorticosteroids (GCS) and interleukin-6 inhibitors (IIL-6) has not yet been developed. OBJECTIVE: Assessment of the effectiveness of cyclosporine A in patients with COVID-19 with progression of lung damage and hypoxemic acute respiratory failure, who received therapy with GCS and IIL-6. MATERIALS AND METHODS: A retrospective cohort propensity-score matched analysis (n = 98). Cyclosporine A was prescribed in the first 72–96 hours after IIL-6 administration when the patient's condition worsened. The patients of comparison group corresponded to the study group, but did not receive cyclosporine A therapy. The primary end point was in-hospital mortality. Secondary endpoints — duration of hospitalization, number of patients admitted to the intensive care unit (ICU), need for respiratory support. RESULTS: Mortality was 12 (22) % in the cyclosporine group and 27 (61) % in the comparison group, р = 0.001 (hazard ratio [HR] 2.00 (1.12–3.48), р = 0.018), ICU admission rate 14 (26) % vs 29 (66) %, р = 0.001, respectively. In the cyclosporine group on day 7 CT-4, there were 26 % of patients vs 52 % in the control group, р = 0.014, the need for respiratory support (37 % vs 63.6 %, р = 0.011); saturation 88 % (82–93) vs 80 % (70–86), р = 0.001, respectively. The need for respiratory support at day 11 after IIL-6 increased the likelihood of death (HR 7.10 (2.5–20), р = 0.001). Risk factors for death: age over 57.5 years, body mass index over 30 kg/m2, hemoglobin oxygen saturation below 85.5 % on the day of IIL-6 application. Duration of hospitalization was 18.5 (14–24) days vs 18 (12–24) days, р = 0.778. CONCLUSIONS: Cyclosporine A in addition to GCS and IIL-6 for COVID-19 therapy may reduce mortality, ICU admissions, and respiratory support requirements.