ABSTRACT
OBJECTIVES: To assess the effectiveness and safety of tocilizumab, a humanised anti-interleukin-6 receptor antibody, in the treatment of critical or severe coronavirus disease 2019 (COVID-19) patients. METHODS: This was a retrospective cohort study of severe or critical COVID-19 patients (≥18 years) admitted to one hospital in Kuwait. Fifty-one patients received intravenous tocilizumab, while 78 patients received the standard of care at the same hospital. Both groups were compared for clinical improvement and in-hospital mortality. RESULTS: The tocilizumab (TCZ) group had a significantly lower 28-day in-hospital mortality rate than the standard-of care-group (21.6% vs. 42.3% respectively; p = 0.015). Fifty-five per cent of patients in the TCZ group clinically improved vs. 11.5% in the standard-of-care group (p < 0.001). Using Cox-proportional regression analysis, TCZ treatment was associated with a reduced risk of mortality (adjusted hazard ratio 0.25; 95% CI: 0.11-0.61) and increased likelihood of clinical improvement (adjusted hazard ratio 4.94; 95% CI: 2.03-12.0), compared to the standard of care. The median C-reactive protein, D-dimer, procalcitonin, lactate dehydrogenase and ferritin levels in the tocilizumab group decreased significantly over the 14 days of follow-up. Secondary infections occurred in 19.6% of the TCZ group, and in 20.5% of the standard-of-care group, with no statistical significance (p = 0.900). CONCLUSION: Tocilizumab was significantly associated with better survival and greater clinical improvement in severe or critical COVID-19 patients.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Drug Treatment , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cohort Studies , Female , Humans , Kuwait/epidemiology , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Infected cells and DCs can stimulate the innate immunity by secreting interferons (IFN) which may further interact with healthy cells to improve the resistant against to the infection and also prevent the viral spread effectively. DCs population along with the expression of MHCs, chemokine receptors and TRAIL on DCs are very important markers for identifying the immune responses against COVID-19 infection during the viral progression and treatment of different category of patients.