Tocilizumab for Treatment of Mechanically Ventilated Patients With COVID-19.

Autor:	Somers EC; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.; Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.; Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA., Eschenauer GA; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA., Troost JP; Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, Michigan, USA., Golob JL; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Gandhi TN; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Wang L; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA., Zhou N; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA., Petty LA; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Baang JH; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Dillman NO; Department of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA., Frame D; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA., Gregg KS; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Kaul DR; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Nagel J; Department of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA., Patel TS; Department of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA., Zhou S; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Lauring AS; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Hanauer DA; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA., Martin E; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA., Sharma P; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Fung CM; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA., Pogue JM; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Jul 15; Vol. 73 (2), pp. e445-e454.
DOI:	10.1093/cid/ciaa954
Abstrakt:	Background: Severe coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment. Methods: We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared with tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability of treatment weighting (IPTW). Results: 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range, 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean: 55 vs 60 years), less likely to have chronic pulmonary disease (10% vs 28%), and had lower D-dimer values at time of intubation (median: 2.4 vs 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death (HR, .55; 95% CI, .33-.90) and improved status on the ordinal outcome scale [OR per 1-level increase, .58; .36-.94). Although tocilizumab was associated with an increased proportion of patients with superinfections (54% vs 26%; P < .001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection (22% vs 15%; P = .42). Staphylococcus aureus accounted for ~50% of bacterial pneumonia. Conclusions: In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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