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Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study.
J Med Virol. 2021 02; 93(2):831-842.JM

Abstract

Coronavirus disease 2019 (COVID-19) can lead to a massive cytokine release. The use of the anti-interleukin-6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID-19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6-point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6-point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon-β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06-0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06-0.99; P = .048) were negatively associated with clinical improvement by day 7. All-cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO2 ratio increased by days 3 and 5, whereas C-reactive protein levels dropped by day 2. There were no TCZ-attributable adverse events. In this observational single-center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID-19 pneumonia.

Authors+Show Affiliations

Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Cardiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Pharmacy, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Intensive Care Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Pneumology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Medical Oncology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Immunology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Hematology, Centro Nacional de Investigaciones Oncológicas (CNIO), Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain.Department of Emergency Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32672860

Citation

Fernández-Ruiz, Mario, et al. "Tocilizumab for the Treatment of Adult Patients With Severe COVID-19 Pneumonia: a Single-center Cohort Study." Journal of Medical Virology, vol. 93, no. 2, 2021, pp. 831-842.
Fernández-Ruiz M, López-Medrano F, Pérez-Jacoiste Asín MA, et al. Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study. J Med Virol. 2021;93(2):831-842.
Fernández-Ruiz, M., López-Medrano, F., Pérez-Jacoiste Asín, M. A., Maestro de la Calle, G., Bueno, H., Caro-Teller, J. M., Catalán, M., de la Calle, C., García-García, R., Gómez, C., Laguna-Goya, R., Lizasoáin, M., Martínez-López, J., Origüen, J., Pablos, J. L., Ripoll, M., San Juan, R., Trujillo, H., Lumbreras, C., & Aguado, J. M. (2021). Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study. Journal of Medical Virology, 93(2), 831-842. https://doi.org/10.1002/jmv.26308
Fernández-Ruiz M, et al. Tocilizumab for the Treatment of Adult Patients With Severe COVID-19 Pneumonia: a Single-center Cohort Study. J Med Virol. 2021;93(2):831-842. PubMed PMID: 32672860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study. AU - Fernández-Ruiz,Mario, AU - López-Medrano,Francisco, AU - Pérez-Jacoiste Asín,María Asunción, AU - Maestro de la Calle,Guillermo, AU - Bueno,Héctor, AU - Caro-Teller,José Manuel, AU - Catalán,Mercedes, AU - de la Calle,Cristina, AU - García-García,Rocío, AU - Gómez,Carlos, AU - Laguna-Goya,Rocío, AU - Lizasoáin,Manuel, AU - Martínez-López,Joaquín, AU - Origüen,Julia, AU - Pablos,José Luis, AU - Ripoll,Mar, AU - San Juan,Rafael, AU - Trujillo,Hernando, AU - Lumbreras,Carlos, AU - Aguado,José María, Y1 - 2020/07/27/ PY - 2020/06/16/received PY - 2020/07/13/accepted PY - 2020/7/17/pubmed PY - 2021/1/15/medline PY - 2020/7/17/entrez KW - COVID-19 KW - SARS-CoV-2 KW - immunomodulation KW - pneumonia KW - tocilizumab SP - 831 EP - 842 JF - Journal of medical virology JO - J Med Virol VL - 93 IS - 2 N2 - Coronavirus disease 2019 (COVID-19) can lead to a massive cytokine release. The use of the anti-interleukin-6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID-19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6-point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6-point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon-β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06-0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06-0.99; P = .048) were negatively associated with clinical improvement by day 7. All-cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO2 ratio increased by days 3 and 5, whereas C-reactive protein levels dropped by day 2. There were no TCZ-attributable adverse events. In this observational single-center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID-19 pneumonia. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32672860/Tocilizumab_for_the_treatment_of_adult_patients_with_severe_COVID_19_pneumonia:_A_single_center_cohort_study_ L2 - https://doi.org/10.1002/jmv.26308 DB - PRIME DP - Unbound Medicine ER -