Tocilizumab Treatment for Cytokine Release Syndrome in Hospitalized Patients With Coronavirus Disease 2019: Survival and Clinical Outcomes.
Tocilizumab Treatment for Cytokine Release Syndrome in Hospitalized Patients With Coronavirus Disease 2019: Survival and Clinical Outcomes.
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DOI：
10.1016/j.chest.2020.06.006
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发表时间：
2020-10
期刊：
影响因子：
9.6
通讯作者：
Malinis M
中科院分区：
文献类型：
--
作者：
Price CC;Altice FL;Shyr Y;Koff A;Pischel L;Goshua G;Azar MM;Mcmanus D;Chen SC;Gleeson SE;Britto CJ;Azmy V;Kaman K;Gaston DC;Davis M;Burrello T;Harris Z;Villanueva MS;Aoun-Barakat L;Kang I;Seropian S;Chupp G;Bucala R;Kaminski N;Lee AI;LoRusso PM;Topal JE;Dela Cruz C;Malinis M
Tocilizumab是一种IL-6受体拮抗剂，可用于治疗细胞因子释放综合征(CRS)，在冠状病毒病2019(新冠肺炎)病例系列中观察到改善。这项研究的目标是确定tocilizumab是否有利于新冠肺炎患者住院治疗。这项观察性研究采用图表回顾的方法，对2020年3月10日至2020年3月31日期间连续入院的新冠肺炎患者进行了跟踪调查，直至2020年4月21日。患者接受tocilizumab治疗，使用的是针对CRS的算法。报告了14天的存活和机械通气(MV)结果，并根据入院时指定的疾病严重程度进行分层(严重，≥3和L补充氧气以维持氧饱和度>；93%)。对于接受tocilizumab治疗的患者，评估了临床反应、生物标记物和安全结果的前后分析。对种族/民族进行了事后生存分析。在239名患者中，年龄中值为；黑人和西班牙裔分别为36%和19%。医院人口普查呈指数增长，而MV人口普查却没有。严重疾病与较低的存活率(78%比0.93%；P<0.01)、较大的需要机械通气的比例(44%比0.5%；P<0.01)和较长的中位机械通气天数(5.5%比1.0%；P=0.003)有关。接受tocilizumab治疗的患者(n=153[%])占重症患者的90%；非重症患者中有44%接受tocilizumab治疗以发展CRS。接受tocilizumab治疗的重症患者入院时高敏C反应蛋白水平较高(120vs0.71 mg/L；P<0.01)，且接受tocilizumab治疗的时间较早(2vs3.30天；p0.01)，但他们的存活率与非重症患者相似(83%vs0.91%；P=.11)。接受Tocilizumab治疗的患者需要MV，生存率为75%(CI为95%，-89)。托西珠单抗治疗后几乎没有不良事件发生，氧合和炎症生物标志物(如高敏C反应蛋白，IL-6)得到改善，但D-二聚体和可溶性IL-2受体(也称为CD25)水平显著升高。在控制了年龄后，黑人和西班牙裔患者的存活率显著高于白人患者(对数等级检验，P=0.002)。包括tocilizumab在内的靶向CRS的治疗算法可能会影响MV和生存结果。在接受tocilizumab治疗的患者中，氧合和炎症生物标志物得到改善，存活率高于预期。随机试验必须证实这些发现。
Tocilizumab, an IL-6 receptor antagonist, can be used to treat cytokine release syndrome (CRS), with observed improvements in a coronavirus disease 2019 (COVID-19) case series. The goal of this study was to determine if tocilizumab benefits patients hospitalized with COVID-19. This observational study of consecutive COVID-19 patients hospitalized between March 10, 2020, and March 31, 2020, and followed up through April 21, 2020, was conducted by chart review. Patients were treated with tocilizumab using an algorithm that targeted CRS. Survival and mechanical ventilation (MV) outcomes were reported for 14 days and stratified according to disease severity designated at admission (severe, ≥ 3 L supplemental oxygen to maintain oxygen saturation > 93%). For tocilizumab-treated patients, pre/post analyses of clinical response, biomarkers, and safety outcomes were assessed. Post hoc survival analyses were conducted for race/ethnicity. Among the 239 patients, median age was 64 years; 36% and 19% were black and Hispanic, respectively. Hospital census increased exponentially, yet MV census did not. Severe disease was associated with lower survival (78% vs 93%; P < .001), greater proportion requiring MV (44% vs 5%; P < .001), and longer median MV days (5.5 vs 1.0; P = .003). Tocilizumab-treated patients (n = 153 [64%]) comprised 90% of those with severe disease; 44% of patients with nonsevere disease received tocilizumab for evolving CRS. Tocilizumab-treated patients with severe disease had higher admission levels of high-sensitivity C-reactive protein (120 vs 71 mg/L; P < .001) and received tocilizumab sooner (2 vs 3 days; P < .001), but their survival was similar to that of patients with nonsevere disease (83% vs 91%; P = .11). For tocilizumab-treated patients requiring MV, survival was 75% (95% CI, 64-89). Following tocilizumab treatment, few adverse events occurred, and oxygenation and inflammatory biomarkers (eg, high-sensitivity C-reactive protein, IL-6) improved; however, D-dimer and soluble IL-2 receptor (also termed CD25) levels increased significantly. Survival in black and Hispanic patients, after controlling for age, was significantly higher than in white patients (log-rank test, P = .002). A treatment algorithm that included tocilizumab to target CRS may influence MV and survival outcomes. In tocilizumab-treated patients, oxygenation and inflammatory biomarkers improved, with higher than expected survival. Randomized trials must confirm these findings.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
DOI：
10.1164/rccm.202002-0445oc
发表时间：
2020-06-01
影响因子：
24.7
作者：
Feng, Yun;Ling, Yun;Qu, Jieming
通讯作者：
Qu, Jieming
影响因子：
39.2
作者：
Weissman, Gary E.;Crane-Droesch, Andrew;Halpern, Scott D.
通讯作者：
Halpern, Scott D.
影响因子：
39
作者：
Lowe, Dylan A.;Wu, Nancy;Weiss, Ethan J.
通讯作者：
Weiss, Ethan J.
影响因子：
8.1
作者：
Chen, Hongli;Wang, Fangxia;He, Aili
通讯作者：
He, Aili