Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series.
Identifieur interne : 000071 ( Main/Exploration ); précédent : 000070; suivant : 000072Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series.
Auteurs : Matt G. Mckenzie [États-Unis] ; Yeunju Michelle Lee [États-Unis] ; Julin Mathew [États-Unis] ; Megan Anderson [États-Unis] ; Alison T. Vo [États-Unis] ; Samuel Akinyele [États-Unis] ; Malarvizhi Narayanan [États-Unis]Source :
- Journal of pharmacy practice [ 1531-1937 ] ; 2021.
Abstract
OBJECTIVE
To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19.
DESIGN
A retrospective case series.
SETTING
Five community hospitals within 1 urban health system.
PATIENTS
Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao
CONCLUSIONS
Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.
DOI: 10.1177/08971900211002353
PubMed: 33736526
Affiliations:
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Mckenzie</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Lee, Yeunju Michelle" sort="Lee, Yeunju Michelle" uniqKey="Lee Y" first="Yeunju Michelle" last="Lee">Yeunju Michelle Lee</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Mathew, Julin" sort="Mathew, Julin" uniqKey="Mathew J" first="Julin" last="Mathew">Julin Mathew</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann Greater Heights Hospital, Houston, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann Greater Heights Hospital, Houston, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Anderson, Megan" sort="Anderson, Megan" uniqKey="Anderson M" first="Megan" last="Anderson">Megan Anderson</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann Southeast Hospital, Houston, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann Southeast Hospital, Houston, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Vo, Alison T" sort="Vo, Alison T" uniqKey="Vo A" first="Alison T" last="Vo">Alison T. Vo</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann Memorial City Medical Center, Houston, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann Memorial City Medical Center, Houston, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Akinyele, Samuel" sort="Akinyele, Samuel" uniqKey="Akinyele S" first="Samuel" last="Akinyele">Samuel Akinyele</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Narayanan, Malarvizhi" sort="Narayanan, Malarvizhi" uniqKey="Narayanan M" first="Malarvizhi" last="Narayanan">Malarvizhi Narayanan</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author></analytic><series><title level="j">Journal of pharmacy practice</title><idno type="eISSN">1531-1937</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>A retrospective case series.</p></div><div type="abstract" xml:lang="en"><p><b>SETTING</b></p><p>Five community hospitals within 1 urban health system.</p></div><div type="abstract" xml:lang="en"><p><b>PATIENTS</b></p><p>Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>None.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND MAIN RESULTS</b></p><p>Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33736526</PMID><DateRevised><Year>2021</Year><Month>03</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1531-1937</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Mar</Month><Day>19</Day></PubDate></JournalIssue><Title>Journal of pharmacy practice</Title><ISOAbbreviation>J Pharm Pract</ISOAbbreviation></Journal><ArticleTitle>Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series.</ArticleTitle><Pagination><MedlinePgn>8971900211002353</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1177/08971900211002353</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="UNASSIGNED">To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19.</AbstractText><AbstractText Label="DESIGN" NlmCategory="UNASSIGNED">A retrospective case series.</AbstractText><AbstractText Label="SETTING" NlmCategory="UNASSIGNED">Five community hospitals within 1 urban health system.</AbstractText><AbstractText Label="PATIENTS" NlmCategory="UNASSIGNED">Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="UNASSIGNED">None.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS" NlmCategory="RESULTS">Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao<sub>2</sub>: Fio<sub>2</sub> of 84 (69 - 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="UNASSIGNED">Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>McKenzie</LastName><ForeName>Matt G</ForeName><Initials>MG</Initials><Identifier Source="ORCID">https://orcid.org/0000-0003-1945-9471</Identifier><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Yeunju Michelle</ForeName><Initials>YM</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-8618-9267</Identifier><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann The Woodlands Hospital, The Woodlands, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mathew</LastName><ForeName>Julin</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann Greater Heights Hospital, Houston, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Anderson</LastName><ForeName>Megan</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann Southeast Hospital, Houston, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vo</LastName><ForeName>Alison T</ForeName><Initials>AT</Initials><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann Memorial City Medical Center, Houston, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akinyele</LastName><ForeName>Samuel</ForeName><Initials>S</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-4082-0877</Identifier><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Narayanan</LastName><ForeName>Malarvizhi</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pharmacy Services, Memorial Hermann Southwest Hospital, Beechnut, Houston, TX, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>03</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Pharm Pract</MedlineTA><NlmUniqueID>8900945</NlmUniqueID><ISSNLinking>0897-1900</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">critical care</Keyword><Keyword MajorTopicYN="N">cytokine release syndrome</Keyword><Keyword MajorTopicYN="N">pneumonia</Keyword><Keyword MajorTopicYN="N">tocilizumab</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>3</Month><Day>19</Day><Hour>5</Hour><Minute>44</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>3</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>3</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33736526</ArticleId><ArticleId IdType="doi">10.1177/08971900211002353</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Texas</li></region></list><tree><country name="États-Unis"><region name="Texas"><name sortKey="Mckenzie, Matt G" sort="Mckenzie, Matt G" uniqKey="Mckenzie M" first="Matt G" last="Mckenzie">Matt G. Mckenzie</name></region><name sortKey="Akinyele, Samuel" sort="Akinyele, Samuel" uniqKey="Akinyele S" first="Samuel" last="Akinyele">Samuel Akinyele</name><name sortKey="Anderson, Megan" sort="Anderson, Megan" uniqKey="Anderson M" first="Megan" last="Anderson">Megan Anderson</name><name sortKey="Lee, Yeunju Michelle" sort="Lee, Yeunju Michelle" uniqKey="Lee Y" first="Yeunju Michelle" last="Lee">Yeunju Michelle Lee</name><name sortKey="Mathew, Julin" sort="Mathew, Julin" uniqKey="Mathew J" first="Julin" last="Mathew">Julin Mathew</name><name sortKey="Narayanan, Malarvizhi" sort="Narayanan, Malarvizhi" uniqKey="Narayanan M" first="Malarvizhi" last="Narayanan">Malarvizhi Narayanan</name><name sortKey="Vo, Alison T" sort="Vo, Alison T" uniqKey="Vo A" first="Alison T" last="Vo">Alison T. Vo</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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