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Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge.
Int J Infect Dis. 2020 Jul 25; 99:28-33.IJ

Abstract

OBJECTIVE

The aim of this observational study was to determine the optimal timing of interleukin-6 receptor inhibitor (IL6ri) administration for coronavirus disease 2019 (COVID-19).

METHODS

Patients with COVID-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into two groups: those requiring ≤45% fraction of inspired oxygen (FiO2) (termed stage IIB) and those requiring >45% FiO2 (termed stage III) at the time of IL6ri administration. The main outcomes were all-cause mortality, discharge alive from hospital, and extubation.

RESULTS

A total of 255 COVID-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than those treated in stage III (adjusted hazard ratio (aHR) 0.24, 95% confidence interval (CI) 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR 1.43, 95% CI 1.06-1.93) and were less likely to be intubated (aHR 0.43, 95% CI 0.24-0.79).

CONCLUSIONS

IL6ri administration prior to >45% FiO2 requirement was associated with improved COVID-19 outcomes. This can guide clinical management pending results from randomized controlled trials.

Authors+Show Affiliations

Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; National Emerging Infectious Disease Laboratory, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA, USA.Department of Pharmacy, Boston Medical Center, Boston, MA, USA.Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. Electronic address: msagar@bu.edu.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32721528

Citation

Sinha, Pranay, et al. "Early Administration of Interleukin-6 Inhibitors for Patients With Severe COVID-19 Disease Is Associated With Decreased Intubation, Reduced Mortality, and Increased Discharge." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 99, 2020, pp. 28-33.
Sinha P, Mostaghim A, Bielick CG, et al. Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge. Int J Infect Dis. 2020;99:28-33.
Sinha, P., Mostaghim, A., Bielick, C. G., McLaughlin, A., Hamer, D. H., Wetzler, L. M., Bhadelia, N., Fagan, M. A., Linas, B. P., Assoumou, S. A., Ieong, M. H., Lin, N. H., Cooper, E. R., Brade, K. D., White, L. F., Barlam, T. F., & Sagar, M. (2020). Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 99, 28-33. https://doi.org/10.1016/j.ijid.2020.07.023
Sinha P, et al. Early Administration of Interleukin-6 Inhibitors for Patients With Severe COVID-19 Disease Is Associated With Decreased Intubation, Reduced Mortality, and Increased Discharge. Int J Infect Dis. 2020 Jul 25;99:28-33. PubMed PMID: 32721528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge. AU - Sinha,Pranay, AU - Mostaghim,Anahita, AU - Bielick,Catherine G, AU - McLaughlin,Angela, AU - Hamer,Davidson H, AU - Wetzler,Lee M, AU - Bhadelia,Nahid, AU - Fagan,Maura A, AU - Linas,Benjamin P, AU - Assoumou,Sabrina A, AU - Ieong,Michael H, AU - Lin,Nina H, AU - Cooper,Ellen R, AU - Brade,Karrine D, AU - White,Laura F, AU - Barlam,Tamar F, AU - Sagar,Manish, AU - ,, Y1 - 2020/07/25/ PY - 2020/07/08/received PY - 2020/07/16/revised PY - 2020/07/18/accepted PY - 2020/7/30/pubmed PY - 2020/7/30/medline PY - 2020/7/30/entrez KW - COVID-19 KW - Cytokine release syndrome KW - Interleukin-6 inhibitors KW - Sarilumab KW - Tocilizumab SP - 28 EP - 33 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 99 N2 - OBJECTIVE: The aim of this observational study was to determine the optimal timing of interleukin-6 receptor inhibitor (IL6ri) administration for coronavirus disease 2019 (COVID-19). METHODS: Patients with COVID-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into two groups: those requiring ≤45% fraction of inspired oxygen (FiO2) (termed stage IIB) and those requiring >45% FiO2 (termed stage III) at the time of IL6ri administration. The main outcomes were all-cause mortality, discharge alive from hospital, and extubation. RESULTS: A total of 255 COVID-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than those treated in stage III (adjusted hazard ratio (aHR) 0.24, 95% confidence interval (CI) 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR 1.43, 95% CI 1.06-1.93) and were less likely to be intubated (aHR 0.43, 95% CI 0.24-0.79). CONCLUSIONS: IL6ri administration prior to >45% FiO2 requirement was associated with improved COVID-19 outcomes. This can guide clinical management pending results from randomized controlled trials. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/32721528/Early_administration_of_Interleukin-6_inhibitors_for_patients_with_severe_Covid-19_disease_is_associated_with_decreased_intubation,_reduced_mortality,_and_increased_discharge L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(20)30568-3 DB - PRIME DP - Unbound Medicine ER -
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