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Tocilizumab in the treatment of critical COVID-19 pneumonia: A retrospective cohort study of mechanically ventilated patients

Fisher et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.12.021, Feb 2021
https://c19early.org/fisher.html
Mortality -4% Improvement Relative Risk Tocilizumab  Fisher et al.  LATE TREATMENT Is late treatment with tocilizumab beneficial for COVID-19? Retrospective 115 patients in the USA (March - April 2020) No significant difference in mortality c19early.org Fisher et al., Int. J. Infectious Dise.., Feb 2021 Favorstocilizumab Favorscontrol 0 0.5 1 1.5 2+
Retrospective 115 mechanically ventilated COVID-19 patients showing no mortality benefit with tocilizumab treatment.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
risk of death, 4.0% higher, OR 1.04, p = 0.96, treatment 45, control 70, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fisher et al., 28 Feb 2021, retrospective, USA, peer-reviewed, 5 authors, study period 10 March, 2020 - 2 April, 2020. Contact: roderick.go@stonybrookmedicine.edu.
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
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Late treatment
is less effective
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