Dynamics of cytokines (IFNγ, IFNα, IL18, TNFα) in the treatment of intermediate influenza A (H1N1) pdm09 (2013-2016) with Oseltamivir (Tamiflu) and Umifenovir (Arbidol) in monotherapy and in combination with Kagocel

Aim. To assess correlation of cytokines levels and therapy regimes a relationship of the time course of changes in the cytokines IFN-gamma, IFN-alpha, IL-18, and TNF-alpha to the treatment option for influenza A (H1N1) pdm09 with umifenovir (Arbidol) 800 mg/day for 5 days (n=50); oseltamivir (Tamiflu) 150 mg/day for 5 days (n=50); umifenovir (Arbidol) 800 mg/day for 5 days in combination with Kagocel 72 mg/day for 2 days.; 36 mg/day for 2 days (n=50); oseltamivir ((Tamiflu) (150 mg/day for 5 days) in combination with Kagocel 72 mg/day for 2 days; 36 mg/day for 2 days (n=50). A comparison group consisted of 30 healthy volunteers. Material and methods. The state of immunologic reactivity was assessed twice: at admission of the patients to an infectious disease clinic (at 1-3 disease days) and in the early convalescent period (at 7-8 disease days): venous blood samples were collected to determine the concentrations of IFN-gamma, IFN-alpha, IL-18, and TNF-alpha by a solid-phase enzyme immunoassay. Results. All the patients in the acute phase of influenza A showed a statistically significant increase in the levels of IFN-gamma, IFN-alpha, and IL-18 as compared with the control group. The groups receiving monotherapy in the early convalescent period had a decrease in the IFN-gamma, IFN-alpha, and IL-18 concentrations that could be compensated by the combined use of the immunomodulator Kagocel. No statistically significant changes in the levels of TNF-alpha were found in the patients of all the groups, but the groups receiving monotherapy exhibited its lower concentrations in the convalescence period. Conclusion. The combination of etiotropic antiviral drugs with Kagocel enhances the efficiency of antiviral therapy. Monitoring of antiviral cytokines during the treatment of influenza A is a convenient tool to verify the efficiency of antiviral therapy and needs to be more widely introduced into medical practice.