Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study
Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study
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DOI：
10.1016/j.eclinm.2020.100418
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发表时间：
2020-07-01
影响因子：
15.1
通讯作者：
Akbik, Bassel
中科院分区：
文献类型：
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作者：
Kewan, Tariq;Covut, Fahrettin;Akbik, Bassel
背景资料：托珠单抗被批准用于嵌合抗原受体T细胞治疗诱导的细胞因子释放综合征，它可能为选定的COVID-19患者提供临床获益。方法：在这项回顾性队列研究中，我们分析了2020年3月13日至2020年4月19日期间连续入院的缺氧COVID-19患者。如果没有禁忌症，肺浸润和炎症标志物升高的患者接受单剂量托珠单抗治疗。全身性类固醇，羟氯喹，阿奇霉素伴随使用的patients.Findings：纳入分析的51例患者中，28（55%）接受托珠单抗和23（45%）没有接受托珠单抗。托珠单抗队列在基线和整个住院期间（75% vs. 48%）需要更多的有创通气（68% vs. 22%）。托珠单抗队列与无托珠单抗队列相比，至临床改善的中位时间为8天（四分位距[IQR]：6.25 - 9.75天）vs. 13天（IQR：9.75 - 15.25天）（临床改善的风险比：1.83，95%置信区间[CI]：0.57 - 5.84）和所有患者中6.5天与7天（临床改善的风险比：1.14，95% CI：0.55 - 2.38）。托珠单抗与无托珠单抗队列中血管加压药支持和有创机械通气的中位持续时间分别为2天（IQR：1.75 - 4.25天）vs. 5天（IQR：4 - 8天），p = 0.039和7天（IQR：4 - 14天）vs. 10天（IQR：5 - 15天），p = 0.11。两个队列的医院获得性感染发生率相似（托珠单抗组为18%，无托珠单抗组为22%）。解释：在严重COVID-19患者中，托珠单抗与血管加压药支持的持续时间显著缩短相关。尽管没有统计学显著性，但托珠单抗也缩短了临床改善的中位时间和有创通气的持续时间。这些发现需要从正在进行的Tocilizumab在COVID-19患者中的临床试验中得到验证。(C)2020作者（S）爱思唯尔有限公司出版
Background: Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID-19 patients.Methods: In this retrospective cohort study, we analyzed hypoxic COVID-19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients.Findings: Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 6.25 - 9.75 days) vs. 13 days (IQR: 9.75 - 15.25 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 1.83, 95% confidence interval [CI]: 0.57 - 5.84) and 6.5 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 1.14, 95% CI: 0.55 - 2.38), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 1.75 - 4.25 days) vs. 5 days (IQR: 4 - 8 days), p = 0.039, and 7 days (IQR: 4 - 14 days) vs. 10 days (IQR: 5 - 15 days) in tocilizumab vs. no tocilizumab cohorts, p = 0.11, respectively. Similar rates of hospital-acquired infections occurred in both cohorts (18% in tocilizumab and 22% in no tocilizumab cohort).Interpretation: In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID-19 patients. (C) 2020 The Author(s). Published by Elsevier Ltd.