tetano
Editor, Senior Moderator
J Med Virol
. 2020 Nov 17.
doi: 10.1002/jmv.26674. Online ahead of print.
Tocilizumab in hospitalized patients with COVID-19: Clinical outcomes, inflammatory marker kinetics, and safety
Joshua A Hill[SUP] 1 2 3 [/SUP], Manoj P Menon[SUP] 1 2 3 [/SUP], Shireesha Dhanireddy[SUP] 1 [/SUP], Mark M Wurfel[SUP] 1 [/SUP], Margaret Green[SUP] 1 [/SUP], Rupali Jain[SUP] 1 4 [/SUP], Jeannie D Chan[SUP] 1 4 [/SUP], Joanne Huang[SUP] 1 4 [/SUP], Danika Bethune[SUP] 5 [/SUP], Cameron Turtle[SUP] 1 3 [/SUP], Christine Johnston[SUP] 1 2 [/SUP], Hu Xie[SUP] 3 [/SUP], Wendy M Leisenring[SUP] 3 [/SUP], H Nina Kim[SUP] 1 [/SUP], Guang-Shing Cheng[SUP] 1 3 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) due to infection with SARS-CoV-2 causes substantial morbidity. Tocilizumab, an interleukin-6 receptor antagonist, might improve outcomes by mitigating inflammation.
Methods: We conducted a retrospective study of patients admitted to the University of Washington Hospital system with COVID-19 and requiring supplemental oxygen. Outcomes included clinical improvement, defined as a two-point reduction in severity on a 6-point ordinal scale or discharge, and mortality within 28 days. We used Cox proportional-hazards models with propensity score inverse probability weighting to compare outcomes in patients who did and did not receive tocilizumab.
Results: We evaluated 43 patients who received tocilizumab and 45 who did not. Patients receiving tocilizumab were younger with fewer comorbidities but higher baseline oxygen requirements. Tocilizumab treatment was associated with reduced CRP, fibrinogen, and temperature, but there were no meaningful differences in time to clinical improvement (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.38-2.22) or mortality (aHR, 0.57; 95% CI, 0.21-1.52). A numerically higher proportion of tocilizumab-treated patients had subsequent infections, transaminitis, and cytopenias.
Conclusions: Tocilizumab did not improve outcomes in hospitalized patients with COVID-19. However, this study was not powered to detect small differences, and there remains the possibility for a survival benefit. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; SARS-CoV-2; coronavirus; immunomodulatory; tocilizumab.
. 2020 Nov 17.
doi: 10.1002/jmv.26674. Online ahead of print.
Tocilizumab in hospitalized patients with COVID-19: Clinical outcomes, inflammatory marker kinetics, and safety
Joshua A Hill[SUP] 1 2 3 [/SUP], Manoj P Menon[SUP] 1 2 3 [/SUP], Shireesha Dhanireddy[SUP] 1 [/SUP], Mark M Wurfel[SUP] 1 [/SUP], Margaret Green[SUP] 1 [/SUP], Rupali Jain[SUP] 1 4 [/SUP], Jeannie D Chan[SUP] 1 4 [/SUP], Joanne Huang[SUP] 1 4 [/SUP], Danika Bethune[SUP] 5 [/SUP], Cameron Turtle[SUP] 1 3 [/SUP], Christine Johnston[SUP] 1 2 [/SUP], Hu Xie[SUP] 3 [/SUP], Wendy M Leisenring[SUP] 3 [/SUP], H Nina Kim[SUP] 1 [/SUP], Guang-Shing Cheng[SUP] 1 3 [/SUP]
Affiliations
- PMID: 33200828
- DOI: 10.1002/jmv.26674
Abstract
Background: Coronavirus disease 2019 (COVID-19) due to infection with SARS-CoV-2 causes substantial morbidity. Tocilizumab, an interleukin-6 receptor antagonist, might improve outcomes by mitigating inflammation.
Methods: We conducted a retrospective study of patients admitted to the University of Washington Hospital system with COVID-19 and requiring supplemental oxygen. Outcomes included clinical improvement, defined as a two-point reduction in severity on a 6-point ordinal scale or discharge, and mortality within 28 days. We used Cox proportional-hazards models with propensity score inverse probability weighting to compare outcomes in patients who did and did not receive tocilizumab.
Results: We evaluated 43 patients who received tocilizumab and 45 who did not. Patients receiving tocilizumab were younger with fewer comorbidities but higher baseline oxygen requirements. Tocilizumab treatment was associated with reduced CRP, fibrinogen, and temperature, but there were no meaningful differences in time to clinical improvement (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.38-2.22) or mortality (aHR, 0.57; 95% CI, 0.21-1.52). A numerically higher proportion of tocilizumab-treated patients had subsequent infections, transaminitis, and cytopenias.
Conclusions: Tocilizumab did not improve outcomes in hospitalized patients with COVID-19. However, this study was not powered to detect small differences, and there remains the possibility for a survival benefit. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; SARS-CoV-2; coronavirus; immunomodulatory; tocilizumab.