Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.
Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.
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DOI：
10.1016/j.ijid.2020.10.045
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Peces-Barba Romero G
中科院分区：
文献类型：
--
作者：
Górgolas Hernández-Mora M;Cabello Úbeda A;Prieto-Pérez L;Villar Álvarez F;Álvarez Álvarez B;Rodríguez Nieto MJ;Carrillo Acosta I;Fernández Ormaechea I;Al-Hayani AWM;Carballosa P;Calpena Martínez S;Ezzine F;Castellanos González M;Naya A;López De Las Heras M;Rodríguez Guzmán MJ;Cordero Guijarro A;Broncano Lavado A;Macías Valcayo A;Martín García M;Bécares Martínez J;Fernández Roblas R;Piris Pinilla MÁ;Fortes Alen J;Sánchez Pernaute O;Romero Bueno F;Heili-Frades S;Peces-Barba Romero G
托珠单抗（TCZ）是一种白细胞介素6受体拮抗剂，用于治疗重症SARS-CoV-2肺炎（SSP），旨在改善细胞因子释放综合征（CRS）引起的急性呼吸窘迫综合征（ARDS）。然而，没有一致的数据表明谁可能从中受益最多。我们在同情使用的基础上对住院的SSP患者（不包括重症监护和插管病例）和需要氧支持以达到饱和度> 93%的患者给予TCZ。主要终点为给药24小时后插管或死亡。患者于2020年3月8日至2020年4月20日接受至少一剂400 mg静脉TCZ。共研究了207例患者，分析了186例患者。平均年龄为65岁，68%为男性患者。在68%的病例中存在共存条件。死亡的预后因素是年龄较大，较高的IL-6，D-二聚体和高敏C-反应蛋白（HSCRP），总淋巴细胞减少，和严重的疾病，需要额外的氧气支持。当氧气支持较高（FiO 2>0.5%）时，接受药物治疗的患者的主要终点（插管或死亡）明显最差（37% vs 13%，p <0.001）。TCZ在SSP患者中耐受性良好，但对高氧支持需求病例的进展影响有限。
Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.
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影响因子：
25.4
作者：
Guaraldi, Giovanni;Meschiari, Marianna;Mussini, Cristina
通讯作者：
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影响因子：
158.5
作者：
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