Tocilizumab in the treatment of critical COVID-19 pneumonia: A retrospective cohort study of mechanically ventilated patients
Matthew J Fisher, Luis A Marcos Raymundo, Melinda Monteforte, Erin M Taub, Roderick Go
doi:10.1016/j.ijid.2020.12.0211201-9712/
Objectives: The purpose of this study is to evaluate clinical outcomes in patients with critical COVID-19 pneumonia requiring invasive mechanical ventilation who were treated with tocilizumab Design: Single-center retrospective cohort study Setting: Stony Brook University Hospital, a 600-bed academic tertiary medical center in Suffolk County, New York Participants: Consecutive patients with COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) who were admitted to Stony Brook University Hospital between March 10 and April 2 2020 and required mechanical ventilation in any intensive care unit during their hospitalization Exposure: Treatment with tocilizumab while intubated Main Outcome: Overall mortality 30 days from the date of intubation Results: Forty-five patients received tocilizumab compared to seventy controls. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and sequential organ failure assessment (SOFA) scores were similar between the two cohorts. Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 vs 3.0,P = 0.01) than controls. There was a trend towards younger mean age in the tocilizumab exposed group (56.2 vs 60.6; P = 0.09). In logistic regression analysis there was no reduction in mortality associated with receipt of tocilizumab (odds ratio (OR) 1.04; 95% CI, 0.27-3.75). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 vs 25.7; OR 1.17; 95% CI, 0.51-2.71). Conclusion: When controlling for age, severity of illness, and co-morbidities, tocilizumab was not associated with reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine the role of tocilizumab in the treatment of COVID-19.
Declaration of interest The authors declare no conflicts of interest.
Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi: https://doi.org/10.1016/j.ijid.2020.12.021 .
References
Biran, Ip, Ahn, Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study, Lancet Rheumatol,
doi:10.1016/S2665-9913(20)30277-0
Chen, Wu, Guo, Clinical and Immunologic Features of Severe and Moderate Coronavirus Disease 2019, J Clin Invest,
doi:10.1172/JCI137244
Fisher, Marcos Raymundo, Monteforte, None, International Journal of Infectious Diseases
Group, Horby, Lim, Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report, N Engl J Med,
doi:10.1056/NEJMoa2021436
Ruan, Yang, Wang, Jiang, Song, Clinical Predictors of Mortality due to COVID-19 Based on an Analysis of Data of 150 Patients from Wuhan China, Intensive Care Med,
doi:10.1007/s00134-020-05991-x
Sinha, Mostaghim, Bielick, Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge [published online ahead of print, Int J Infect Dis
Somers, Eschenauer, Troost, Tocilizumab for treatment of mechanically ventilated patients with COVID-19, Clin Infect Dis,
doi:10.1093/cid/ciaa954
Zhang, Wu, Li, Zhao, Wang, The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality, Int J Antimicrob Agents,
doi:10.1016/j.ijantimicag.2020.105954
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