Effect of pharmacotherapy on the immune response in patients with COVID-19

Background. The effect of pharmacotherapy used to treat patients with the new coronavirus infection COVID-19 on immune parameters after treatment has not been sufficiently studied.

Aim. To study the effectiveness of pharmacotherapy and evaluate its impact on the immune response in patients with COVID-19.

Material and methods. The subjects of the study were 98 patients with COVID-19 aged from 32 to 68 years who were treated at the Penza Regional Clinical Center for Specialized Types of Medical Care from November 2022 to March 2023. The average age of the patients was 50±18 years. Computed tomography revealed pneumonia in all patients (CT1–CT4). The outpatient observation group included patients with COVID-19 (n=32), who were characterized by a mild course of the disease, 36 patients with moderate severity of COVID-19, and 30 patients with severe and extremely severe disease. Patients with mild COVID-19 received molnupiravir as antiviral therapy, patients with moderate COVID-19 received favipiravir, and patients with severe and extremely severe COVID-19 received remdesivir. After treatment, 72 patients were examined on an outpatient basis 3–4 weeks after discharge from the hospital. In the blood of patients before and after treatment, the populations of T- and B-lymphocytes, the functional activity of T-lymphocytes, cytokine indicators — tumor necrosis factor α, interleukins-4, -10 and -18, interferon γ — in cell supernatants were studied. Statistical analysis of the groups was carried out according to Wilcoxon, differences were considered significantly significant at p <0.05.

Results. In the observation group (98 patients), in patients with mild disease (32 patients), recovery occurred in 31 (96.8%) people. With a moderate course of the disease, a favorable outcome with clinical and laboratory improvement was noted in 33 (91.7%) patients out of 36, and with a severe course of COVID-19 — in 7 (23.4%) patients out of 30, 5 (16.6%) patients died, in 18 (60.0%) people after the 10th day of therapy complications from the cardiovascular system in the form of heart attacks and strokes were noted. After treatment in patients with COVID-19, the immune system showed an increase in the relative number of lymphocytes (p=0.034171), indicators of cytotoxic CD3+CD8+ T cells (p=0.001090), spontaneous synthesis of interferon γ (p=0.003246), induced production of interleukin-18 (p=0.003278), decrease in the absolute number of leukocytes (p=0.004319) and induced synthesis of interleukin-10 (p=0.042439).

Conclusion. Regardless of the type of antiviral therapy administered, a high recovery rate was recorded in patients with mild and moderate disease compared with severe and extremely severe disease.