Efektivitas Pemberian Tocilizumab Dan Imunoglobulin Intravena Pada Pasien COVID-19 Kategori Berat Dan Kritis Ditinjau Dari Kadar IL-6 Di RSSA Malang

Fitria, Nur Abidatul and apt. Dra. Diana Lyrawati,, M.Kes., Ph.D and apt. Efta Triastuti,, S.Si., M.Farm.Klin.,Ph.D (2023) Efektivitas Pemberian Tocilizumab Dan Imunoglobulin Intravena Pada Pasien COVID-19 Kategori Berat Dan Kritis Ditinjau Dari Kadar IL-6 Di RSSA Malang. Sarjana thesis, Universitas Brawijaya.

Abstract

Tahun 2019 dunia telah dihadapkan pada pandemi global penyakit menular COVID-19 yang disebabkan oleh virus SARS-CoV-2. Tingkat kematian pada pasien COVID-19 dilaporkan lebih tinggi apabila kadar sitokin IL-6 meningkat, terutama pada kondisi berat dan kritis. Tujuan penelitian ini, mengevaluasi efektivitas penggunaan terapi Tocilizumab dan Intravenous Immunoglobulin (IVIG) dalam menurunkan kadar IL-6 serta memperbaiki kondisi klinis pasien COVID-19 kategori berat dan kritis di Rumah Sakit Saiful Anwar (RSSA) Malang. Metode penelitian yang digunakan yaitu data rekam medis pasien COVID-19 berat dan kritis dengan parameter kadar IL-6 dan outcome klinis di RSSA Malang periode Januari 2020-Desember 2022. Analisis data dilakukan menggunakan uji kruskal wallis dikarenakan data tidak normal dan uji wilcoxon. Total sampel sebanyak 43 pasien yang memenuhi kriteria inklusi, dimana pasien kontrol sejumlah 13 pasien, kelompok TCZ 11 pasien, kelompok IVIG 9 pasien, dan kelompok kombinasi 10 pasien. Dosis TCZ yang digunakan pada penelitian ini yaitu 400mg dengan lama terapi rata-rata selama 2 hari. Sedangkan dosis IVIG yaitu berkisar 12,5-25g/hari dengan lama terapi rata-rata 5 hari. Pasien COVID-19 berat dan kritis yang mendapat terapi TCZ diketahui mengalami peningkatan IL-6 8 kali lipat namun tidak signifikan dengan outcome klinis sembuh dan perbaikan sebesar 63,34%. Sedangkan pasien COVID-19 yang mendapat terapi IVIG mengalami penurunan IL-6 2 kali lipat namun tidak signifikan dengan outcome klinis meninggal sebesar 66,66%. Pemberian kombinasi Tocilizumab-IVIG tidak memberikan efek menurunkan IL-6 melainkan meningkatkan IL-6 6 kali lipat dan signifikan secara statistik (p=0,013) dengan outcome klinis meninggal sebesar 80%. Kesimpulan, pemberian TCZ lebih baik daripada IVIG atau kombinasi TCZ-IVIG dalam memperbaiki kondisi klinis pasien pulang sembuh walaupun kadar IL-6 tidak turun.

English Abstract

In 2019 the world was faced with a global pandemic of the infectious disease COVID-19 caused by the SARS-CoV-2 virus. The death rate in COVID-19 patients is reported to be higher if IL-6 cytokine levels increase, especially in severe and critical conditions. This study aims to evaluate the effectiveness of using Tocilizumab and Intravenous Immunoglobulin (IVIG) therapy in reducing IL-6 levels and improving the clinical condition of severe and critical COVID-19 patients at Saiful Anwar Hospital (RSSA) Malang. The research method used medical record data from severe and critical COVID-19 patients with parameters of IL-6 levels and clinical outcomes at RSSA Malang for the period January 2020-December 2022. Data analysis was carried out using the Kruskal Wallis test because the data was not normal and the Wilcoxon test. A total sample was 43 patients who met the inclusion criteria, of which 13 were in the control group, 11 in the TCZ group, 9 in the IVIG group, and 10 in the combination group. The TCZ dose used in this study was 400 mg with an average duration of therapy of 2 days. Meanwhile, the IVIG dose ranges from 12.5-25g/day with an average duration of therapy of 5 days. Severe and critical COVID-19 patients who received TCZ therapy were found to experience an 8-fold but not significant increase in IL-6 with clinical outcomes of recovery and improvement of 63.34%. Meanwhile, COVID-19 patients who received IVIG therapy experienced a 2-fold decrease in IL-6 but it was not significant with a clinical outcome of death of 66.66%. Administration of the TCZ-IVIG combination did not have the effect of reducing IL-6 but instead increased IL-6 6-fold and was statistically significant (p=0.013) with a clinical outcome of death of 80%. In conclusion, TCZ administration is better than IVIG or the TCZ-IVIG combination in improving the clinical condition of patients who returned home and recovered even though IL-6 levels do not decrease.

Item Type:	Thesis (Sarjana)
Identification Number:	052306
Uncontrolled Keywords:	COVID-19, IL-6, IVIG, Tocilizumab
Divisions:	Fakultas Kedokteran > Farmasi
Depositing User:	Unnamed user with username ihwan
Date Deposited:	12 Jan 2024 08:55
Last Modified:	12 Jan 2024 08:55
URI:	http://repository.ub.ac.id/id/eprint/209577

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