Use of immunomodulatory therapy as part of comprehensive treatment of non-severe community-acquired pneumonia and its long-term results

Mikhail P Kostinov; Vilia V Gainitdinova; Svetlana V Kazharova; Anna E Vlasenko; Vflentina B Polishchuk; Kirill V Mashilov

doi:10.7573/dic.2022-10-5

Use of immunomodulatory therapy as part of comprehensive treatment of non-severe community-acquired pneumonia and its long-term results

Drugs Context. 2023 Aug 8:12:2022-10-5. doi: 10.7573/dic.2022-10-5. eCollection 2023.

Authors

Mikhail P Kostinov^{1

2}, Vilia V Gainitdinova^{1

2}, Svetlana V Kazharova¹, Anna E Vlasenko³, Vflentina B Polishchuk¹, Kirill V Mashilov¹

Affiliations

¹ Federal State Budgetary Scientific Institution I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia.
² Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the MoH of the Russian Federation, Moscow, Russia.
³ Novokuznetsk State Institute of Advanced Medical Training - Branch of Federal State Budgetary Educational Institution of Additional Education 'Russian Medical Academy of Continuous Professional Education' of the MoH of the Russian Federation, Novokuznetsk, Russia.

Abstract

Background: This study investigates the efficiency of two different types of immunomodulators for the treatment of non-severe community-acquired pneumonia (CAP) and assesses their long-term effects.

Methods: The study included 55 patients with non-severe CAP. Group 1 (control) received only standard CAP therapy; the other two groups received immunomodulators simultaneously with the standard therapy: bacterial lysate for group 2 and azoximer bromide (AzB) for group 3. TNF and IL-6 concentrations were determined on the day of hospitalization as well as on days 13 and 60 of follow-up. For 2 years, we monitored the incidence of low respiratory tract infections (LRTIs) in the same patients with CAP (n=55).

Results: The overall duration of all symptoms was lower in the immunomodulator groups compared with the control group. During treatment, TNF and IL-6 concentrations decreased on days 13 and 60 in all patients; in patients who received immunomodulators, TNF and IL-6 were reliably lower than in control patients. IL-6 concentration decreased on day 60 in the bacterial lysate and AzB treatment groups and did not differ (p=0.72). The odds ratio for the development of LRTIs in the AzB group was 0.15 (0.02-0.93) (p=0.04), suggesting its protective effect.

Conclusion: Inclusion of immunomodulators in the basic treatment of non-severe CAP reduces the duration of symptoms and is associated with improvement of the pro-inflammatory cytokine profile. In 2 years of follow-up, the long-term effects of the immunomodulatory therapy showed a statistically significant lower incidence of LRTIs in the AzB group only. However, given the small sample size of this study, further clinical studies are needed.

Keywords: IL-6; TNF; azoximer bromide; bacterial lysate; non-severe community-acquired pneumonia.