Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study.
Identifieur interne : 000F50 ( Main/Corpus ); précédent : 000F49; suivant : 000F51Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study.
Auteurs : Tariq Kewan ; Fahrettin Covut ; Mohammed J. Al-Jaghbeer ; Lori Rose ; K V Gopalakrishna ; Bassel AkbikSource :
- EClinicalMedicine [ 2589-5370 ] ; 2020.
Abstract
Background
Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID-19 patients.
Methods
In this retrospective cohort study, we analyzed hypoxic COVID-19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients.
Findings
Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 6·25 - 9·75 days) vs. 13 days (IQR: 9·75 - 15·25 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 1·83, 95% confidence interval [CI]: 0·57 - 5·84) and 6·5 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 1·14, 95% CI: 0·55 - 2·38), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 1·75 - 4·25 days) vs. 5 days (IQR: 4 - 8 days),
Interpretation
In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.
DOI: 10.1016/j.eclinm.2020.100418
PubMed: 32766537
PubMed Central: PMC7305505
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study.</title><author><name sortKey="Kewan, Tariq" sort="Kewan, Tariq" uniqKey="Kewan T" first="Tariq" last="Kewan">Tariq Kewan</name><affiliation><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Covut, Fahrettin" sort="Covut, Fahrettin" uniqKey="Covut F" first="Fahrettin" last="Covut">Fahrettin Covut</name><affiliation><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Al Jaghbeer, Mohammed J" sort="Al Jaghbeer, Mohammed J" uniqKey="Al Jaghbeer M" first="Mohammed J" last="Al-Jaghbeer">Mohammed J. Al-Jaghbeer</name><affiliation><nlm:affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Rose, Lori" sort="Rose, Lori" uniqKey="Rose L" first="Lori" last="Rose">Lori Rose</name><affiliation><nlm:affiliation>Department of Pharmacology, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Gopalakrishna, K V" sort="Gopalakrishna, K V" uniqKey="Gopalakrishna K" first="K V" last="Gopalakrishna">K V Gopalakrishna</name><affiliation><nlm:affiliation>Department of Infectious Disease, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Akbik, Bassel" sort="Akbik, Bassel" uniqKey="Akbik B" first="Bassel" last="Akbik">Bassel Akbik</name><affiliation><nlm:affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32766537</idno><idno type="pmid">32766537</idno><idno type="doi">10.1016/j.eclinm.2020.100418</idno><idno type="pmc">PMC7305505</idno><idno type="wicri:Area/Main/Corpus">000F50</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000F50</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study.</title><author><name sortKey="Kewan, Tariq" sort="Kewan, Tariq" uniqKey="Kewan T" first="Tariq" last="Kewan">Tariq Kewan</name><affiliation><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Covut, Fahrettin" sort="Covut, Fahrettin" uniqKey="Covut F" first="Fahrettin" last="Covut">Fahrettin Covut</name><affiliation><nlm:affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Al Jaghbeer, Mohammed J" sort="Al Jaghbeer, Mohammed J" uniqKey="Al Jaghbeer M" first="Mohammed J" last="Al-Jaghbeer">Mohammed J. Al-Jaghbeer</name><affiliation><nlm:affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Rose, Lori" sort="Rose, Lori" uniqKey="Rose L" first="Lori" last="Rose">Lori Rose</name><affiliation><nlm:affiliation>Department of Pharmacology, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Gopalakrishna, K V" sort="Gopalakrishna, K V" uniqKey="Gopalakrishna K" first="K V" last="Gopalakrishna">K V Gopalakrishna</name><affiliation><nlm:affiliation>Department of Infectious Disease, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</nlm:affiliation></affiliation></author><author><name sortKey="Akbik, Bassel" sort="Akbik, Bassel" uniqKey="Akbik B" first="Bassel" last="Akbik">Bassel Akbik</name><affiliation><nlm:affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</nlm:affiliation></affiliation></author></analytic><series><title level="j">EClinicalMedicine</title><idno type="eISSN">2589-5370</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID-19 patients.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>In this retrospective cohort study, we analyzed hypoxic COVID-19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients.</p></div><div type="abstract" xml:lang="en"><p><b>Findings</b></p><p>Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 6·25 - 9·75 days) vs. 13 days (IQR: 9·75 - 15·25 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 1·83, 95% confidence interval [CI]: 0·57 - 5·84) and 6·5 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 1·14, 95% CI: 0·55 - 2·38), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 1·75 - 4·25 days) vs. 5 days (IQR: 4 - 8 days), </p></div><div type="abstract" xml:lang="en"><p><b>Interpretation</b></p><p>In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32766537</PMID><DateRevised><Year>2021</Year><Month>02</Month><Day>13</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">2589-5370</ISSN><JournalIssue CitedMedium="Internet"><Volume>24</Volume><PubDate><Year>2020</Year><Month>Jul</Month></PubDate></JournalIssue><Title>EClinicalMedicine</Title><ISOAbbreviation>EClinicalMedicine</ISOAbbreviation></Journal><ArticleTitle>Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study.</ArticleTitle><Pagination><MedlinePgn>100418</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.eclinm.2020.100418</ELocationID><Abstract><AbstractText Label="Background" NlmCategory="UNASSIGNED">Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID-19 patients.</AbstractText><AbstractText Label="Methods" NlmCategory="UNASSIGNED">In this retrospective cohort study, we analyzed hypoxic COVID-19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients.</AbstractText><AbstractText Label="Findings" NlmCategory="UNASSIGNED">Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 6·25 - 9·75 days) vs. 13 days (IQR: 9·75 - 15·25 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 1·83, 95% confidence interval [CI]: 0·57 - 5·84) and 6·5 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 1·14, 95% CI: 0·55 - 2·38), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 1·75 - 4·25 days) vs. 5 days (IQR: 4 - 8 days), <i>p</i> = 0.039, and 7 days (IQR: 4 - 14 days) vs. 10 days (IQR: 5 - 15 days) in tocilizumab vs. no tocilizumab cohorts, <i>p</i> = 0.11, respectively. Similar rates of hospital-acquired infections occurred in both cohorts (18% in tocilizumab and 22% in no tocilizumab cohort).</AbstractText><AbstractText Label="Interpretation" NlmCategory="UNASSIGNED">In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.</AbstractText><CopyrightInformation>© 2020 The Author(s).</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kewan</LastName><ForeName>Tariq</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Covut</LastName><ForeName>Fahrettin</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Al-Jaghbeer</LastName><ForeName>Mohammed J</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rose</LastName><ForeName>Lori</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Pharmacology, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gopalakrishna</LastName><ForeName>K V</ForeName><Initials>KV</Initials><AffiliationInfo><Affiliation>Department of Infectious Disease, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akbik</LastName><ForeName>Bassel</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, United States.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>06</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>EClinicalMedicine</MedlineTA><NlmUniqueID>101733727</NlmUniqueID><ISSNLinking>2589-5370</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Coronavirus</Keyword><Keyword MajorTopicYN="N">Cytokine release syndrome</Keyword><Keyword MajorTopicYN="N">Interleukin 6</Keyword><Keyword MajorTopicYN="N">SARS–CoV–2</Keyword><Keyword MajorTopicYN="N">Tocilizumab</Keyword></KeywordList><CoiStatement>The authors declare that they have no conflict of interest.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>04</Month><Day>30</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>05</Month><Day>29</Day></PubMedPubDate><PubMedPubDate 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