Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19

Autor: Rafael San-Juan, Mario Fernández-Ruiz, Francisco López-Medrano, Octavio Carretero, Antonio Lalueza, Guillermo Maestro de la Calle, María Asunción Pérez-Jacoiste Asín, Héctor Bueno, José Manuel Caro-Teller, Mercedes Catalán, Cristina de la Calle, Rocío García-García, Carlos Gómez, Rocío Laguna-Goya, Manuel Lizasoáin, Joaquín Martínez-López, Julia Origüen, Ángel Sevillano, Eduardo Gutiérrez, Borja de Miguel, Fernando Aguilar, Patricia Parra, Mar Ripoll, Tamara Ruiz-Merlo, Hernando Trujillo, José Luis Pablos, Estela Paz-Artal, Carlos Lumbreras, José María Aguado
Rok vydání: 2022
Předmět:
Microbiology (medical)
ALT
alanine transaminase
Infectious and parasitic diseases
RC109-216
clinical response
Antibodies
Monoclonal
Humanized
NAT
nucleic acid testing
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
Article
tocilizumab
RT-PCR
reverse transcription polymerase chain reaction
AST
aspartate transaminase
LPV/r
lopinavir/ritonavir
Humans
IL-6
interleukin-6
ARDS
acute respiratory distress syndrome
IQR
interquartile range
Retrospective Studies
COVID-19
coronavirus disease 2019
LDH
lactate dehydrogenase
SARS-CoV-2
TCZ
tocilizumab
COVID-19
HCQ
hydroxychloroquine
General Medicine
ICU
intensive care unit
COVID-19 Drug Treatment
early initiation
predictors
IMV
invasive mechanical ventilation
Infectious Diseases
CRP
C-reactive protein
IFN-β
interferon-β
OTR
oxygen therapy requirements
SCI
Significant clinical improvement
ePO2/FiO2
estimated arterial oxygen/fraction of inspired oxygen ratio
Zdroj: International Journal of Infectious Diseases
International Journal of Infectious Diseases, Vol 117, Iss, Pp 56-64 (2022)
ISSN: 1201-9712
DOI: 10.1016/j.ijid.2022.01.040
Popis: Background: Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients. Methods: We retrospectively analyzed a cohort of patients with severe COVID-19 who received off-label TCZ after recommendation by a local committee and were admitted to the University Hospital “12 de Octubre” until May 2020. The primary end point was a significant clinical improvement (SCI) on day 14 after administration of TCZ. Factors independently related to SCI were analyzed by multivariate logistic regression models. Results: Of 428 (63.3%) patients treated with TCZ, 271 (63.3%) experienced SCI. After adjustment for factors related to unfavorable outcomes, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1–3.55; P = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI: 1.3–8.1; P = 0.01) were independently related to SCI. The rate of SCI significantly decreased according to the time of TCZ administration: 70.2% in the first 48 hours from admission, 58.5% on days 3-7, and 45.1% after day 7 (P = 0.03 and P = 0.001, respectively). Conclusion: TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission.
Databáze: OpenAIRE
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