October 21, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Epidemiology: A 3-patient case series highlights the potential association between COVID-19 and pancreatitis in pediatric patients. The authors report this association based on temporal observations, asserting that clinicians should be aware of COVID-19 as a potential diagnosis in patients with extra-pulmonary presentations such as pancreatitis.

—Understanding the Pathology: A prospective cohort study of PCR-proven or presumed SARS-CoV-2 infected patients at a tertiary care hospital in the Netherlands found that complement factors C3a, C3c and the terminal complement complex (TCC) were elevated in COVID-19 patients sent to the ICU (n=75) compared to non-ICU COVID-19 patients (n=115; p<0.005 for C3a and TCC), and more intense complement activation was present in patients that deceased and in those with thromboembolic events.

—R&D: Diagnosis & Treatments: A randomized controlled trial of patients hospitalized with COVID-19 pneumonia (n=126) conducted across 24 hospitals in Italy compared treatment with tocilizumab versus standard therapy and found 28.3% of patients who received tocilizumab worsened in clinical condition within 14 days compared to 27.0% who received standard of care, 3.3% in the tocilizumab group died versus 1.6% in the standard therapy group, and those who received tocilizumab had a higher incidence of adverse events overall than those who received standard therapy.

· A physician from the Division of Infectious Diseases at University of North Carolina at Chapel Hill examined studies on tocilizumab as a treatment for COVID-19 and found two randomized control trials (RTCs) met predefined efficacy thresholds via reduction of mechanical ventilation or death (EMPACTA, 28 day threshold; CORIMUNO-19, 14 day threshold), suggesting that observational studies have demonstrated a mortality benefit but current RCT data do not adequately support efficacy of tocilizumab in COVID-19 treatment and would recommend against routine use.

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