Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study.

Autor:	Biran N; John Theurer Cancer Center, Hackensack, NJ, USA., Ip A; Division of Outcomes and Value Research, Hackensack, NJ, USA., Ahn J; Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA., Go RC; Hackensack University Medical Center, Hackensack, NJ, USA., Wang S; Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA., Mathura S; COTA, Boston, MA, USA., Sinclaire BA; John Theurer Cancer Center, Hackensack, NJ, USA., Bednarz U; John Theurer Cancer Center, Hackensack, NJ, USA., Marafelias M; John Theurer Cancer Center, Hackensack, NJ, USA., Hansen E; COTA, Boston, MA, USA., Siegel DS; John Theurer Cancer Center, Hackensack, NJ, USA., Goy AH; John Theurer Cancer Center, Hackensack, NJ, USA., Pecora AL; John Theurer Cancer Center, Hackensack, NJ, USA., Sawczuk IS; Hackensack University Medical Center - Hackensack Meridian Health School of Medicine at Seton Hall University, Nutley, NJ, USA., Koniaris LS; Hackensack University Medical Center, Hackensack, NJ, USA., Simwenyi M; Hackensack University Medical Center, Hackensack, NJ, USA., Varga DW; Hackensack University Medical Center, Hackensack, NJ, USA., Tank LK; Hackensack University Medical Center, Hackensack, NJ, USA., Stein AA; Palisades Medical Center, North Bergen, NJ, USA., Allusson V; Mountainside Medical Center, Glen Ridge, NJ, USA., Lin GS; Pascack Valley Medical Center, Westwood, NJ, USA., Oser WF; JFK Medical Center, Edison, NJ, USA., Tuma RA; Bayshore Medical Center, Holmdel, NJ, USA., Reichman J; Riverview Medical Center, Red Bank, NJ, USA., Brusco L Jr; Raritan Bay Medical Center, Old Bridge, and Raritan Bay Medical Center, Perth Amboy, NJ, USA., Carpenter KL; Jersey Shore University Medical Center, Neptune, NJ, USA., Costanzo EJ; Jersey Shore University Medical Center, Neptune, NJ, USA., Vivona V; Ocean Medical Center, Brick Township, and Southern Ocean Medical Center, Stafford Township, NJ, USA., Goldberg SL; Division of Outcomes and Value Research, Hackensack, NJ, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Rheumatology [Lancet Rheumatol] 2020 Oct; Vol. 2 (10), pp. e603-e612. Date of Electronic Publication: 2020 Aug 14.
DOI:	10.1016/S2665-9913(20)30277-0
Abstrakt:	Background: Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed to mitigate the cytokine storm syndrome associated with severe COVID-19. We aimed to investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19. Methods: We did a retrospective observational cohort study at 13 hospitals within the Hackensack Meridian Health network (NJ, USA). We included patients (aged ≥18 years) with laboratory-confirmed COVID-19 who needed support in the ICU. We obtained data from a prospective observational database and compared outcomes in patients who received tocilizumab with those who did not. We applied a multivariable Cox model with propensity score matching to reduce confounding effects. The primary endpoint was hospital-related mortality. The prospective observational database is registered on ClinicalTrials.gov, NCT04347993. Findings: Between March 1 and April 22, 2020, 764 patients with COVID-19 required support in the ICU, of whom 210 (27%) received tocilizumab. Factors associated with receiving tocilizumab were patients' age, gender, renal function, and treatment location. 630 patients were included in the propensity score-matched population, of whom 210 received tocilizumab and 420 did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. Overall median survival from time of admission was not reached (95% CI 23 days-not reached) among patients receiving tocilizumab and was 19 days (16-26) for those who did not receive tocilizumab (hazard ratio [HR] 0·71, 95% CI 0·56-0·89; p=0·0027). In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (HR 0·64, 95% CI 0·47-0·87; p=0·0040). Similar associations with tocilizumab were noted among subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg/dL or higher. Interpretation: In this observational study, patients with COVID-19 requiring ICU support who received tocilizumab had reduced mortality. Results of ongoing randomised controlled trials are awaited. Funding: None. (© 2020 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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