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Tocilizumab treatment in critically ill patients with COVID-19: A retrospective observational study.
Int J Infect Dis. 2021 Apr; 105:245-251.IJ

Abstract

OBJECTIVE

Elevated levels of pro-inflammatory cytokines are observed in severe COVID-19 infections, and cytokine storm is associated with disease severity. Tocilizumab, an interleukin-6 receptor antagonist, is used to treat chimeric antigen receptor T cell-induced cytokine release syndrome and may attenuate the dysregulated immune response in COVID-19. We compared outcomes among tocilizumab-treated and non-tocilizumab-treated critically ill COVID-19 patients.

DESIGN, SETTING, AND PARTICIPANTS

This was a retrospective observational study conducted at a tertiary referral center investigating all patients admitted to the intensive care unit for COVID-19 who had a disposition from the hospital because of death or hospital discharge between March 1 and May 18, 2020 (n = 96). The percentages of death and secondary infections were compared between patients treated with tocilizumab (n = 55) and those who were not (n = 41).

MEASUREMENTS AND MAIN RESULTS

More tocilizumab-treated patients required mechanical ventilation (44/55, 80%) compared to non-treated patients (15/41, 37%; P < 0.001). Of 55 patients treated with tocilizumab, 32 (58%) were on mechanical ventilation at the time of administration, and 12 (22%) progressed to mechanical ventilation after treatment. Of patients treated with tocilizumab requiring mechanical ventilation, 30/44 (68%) were intubated within 1 day of administration. Fewer deaths were observed among tocilizumab-treated patients, both in the overall population (15% vs 37%; P = 0.02) and among the subgroup of patients requiring mechanical ventilation (14% vs 60%; P = 0.001). Secondary infections were not different between the 2 groups (tocilizumab: 31%, non-tocilizumab: 17%; P = 0.16) and were predominantly related to invasive devices, such as urinary and central venous catheters.

CONCLUSIONS

Tocilizumab treatment was associated with fewer deaths compared to non-treatment despite predominantly being used in patients with more advanced respiratory disease.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Transplant Immunology Laboratory, Transplant Immunotherapy Program, United States.Department of Clinical Transformation, Cedars-Sinai Medical Center, Los Angeles, California, United States.Department of Clinical Transformation, Cedars-Sinai Medical Center, Los Angeles, California, United States.Department of Clinical Transformation, Cedars-Sinai Medical Center, Los Angeles, California, United States.Department of Clinical Transformation, Cedars-Sinai Medical Center, Los Angeles, California, United States.Department of Medicine, Division of Nephrology, Transplant Immunology Laboratory, Transplant Immunotherapy Program, United States. Electronic address: stan.jordan@cshs.org.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33609773

Citation

Huang, Edmund, et al. "Tocilizumab Treatment in Critically Ill Patients With COVID-19: a Retrospective Observational Study." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 105, 2021, pp. 245-251.
Huang E, Isonaka S, Yang H, et al. Tocilizumab treatment in critically ill patients with COVID-19: A retrospective observational study. Int J Infect Dis. 2021;105:245-251.
Huang, E., Isonaka, S., Yang, H., Salce, E., Rosales, E., & Jordan, S. C. (2021). Tocilizumab treatment in critically ill patients with COVID-19: A retrospective observational study. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 105, 245-251. https://doi.org/10.1016/j.ijid.2021.02.057
Huang E, et al. Tocilizumab Treatment in Critically Ill Patients With COVID-19: a Retrospective Observational Study. Int J Infect Dis. 2021;105:245-251. PubMed PMID: 33609773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab treatment in critically ill patients with COVID-19: A retrospective observational study. AU - Huang,Edmund, AU - Isonaka,Sharon, AU - Yang,Haoshu, AU - Salce,Erin, AU - Rosales,Elisa, AU - Jordan,Stanley C, Y1 - 2021/02/17/ PY - 2020/11/06/received PY - 2021/02/11/revised PY - 2021/02/12/accepted PY - 2021/2/21/pubmed PY - 2021/5/14/medline PY - 2021/2/20/entrez KW - Acute respiratory distress syndrome KW - COVID-19 KW - Cytokine release syndrome KW - Pneumonia KW - SARS-CoV2 KW - Tocilizumab SP - 245 EP - 251 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 105 N2 - OBJECTIVE: Elevated levels of pro-inflammatory cytokines are observed in severe COVID-19 infections, and cytokine storm is associated with disease severity. Tocilizumab, an interleukin-6 receptor antagonist, is used to treat chimeric antigen receptor T cell-induced cytokine release syndrome and may attenuate the dysregulated immune response in COVID-19. We compared outcomes among tocilizumab-treated and non-tocilizumab-treated critically ill COVID-19 patients. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective observational study conducted at a tertiary referral center investigating all patients admitted to the intensive care unit for COVID-19 who had a disposition from the hospital because of death or hospital discharge between March 1 and May 18, 2020 (n = 96). The percentages of death and secondary infections were compared between patients treated with tocilizumab (n = 55) and those who were not (n = 41). MEASUREMENTS AND MAIN RESULTS: More tocilizumab-treated patients required mechanical ventilation (44/55, 80%) compared to non-treated patients (15/41, 37%; P < 0.001). Of 55 patients treated with tocilizumab, 32 (58%) were on mechanical ventilation at the time of administration, and 12 (22%) progressed to mechanical ventilation after treatment. Of patients treated with tocilizumab requiring mechanical ventilation, 30/44 (68%) were intubated within 1 day of administration. Fewer deaths were observed among tocilizumab-treated patients, both in the overall population (15% vs 37%; P = 0.02) and among the subgroup of patients requiring mechanical ventilation (14% vs 60%; P = 0.001). Secondary infections were not different between the 2 groups (tocilizumab: 31%, non-tocilizumab: 17%; P = 0.16) and were predominantly related to invasive devices, such as urinary and central venous catheters. CONCLUSIONS: Tocilizumab treatment was associated with fewer deaths compared to non-treatment despite predominantly being used in patients with more advanced respiratory disease. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/33609773/Tocilizumab_treatment_in_critically_ill_patients_with_COVID_19:_A_retrospective_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(21)00143-0 DB - PRIME DP - Unbound Medicine ER -