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Tocilizumab for the Treatment of COVID-19 Among Hospitalized Patients: A Matched Retrospective Cohort Analysis.
Ignatius, Elisa H; Wang, Kunbo; Karaba, Andrew; Robinson, Matthew; Avery, Robin K; Blair, Paul; Chida, Natasha; Jain, Tania; Petty, Brent G; Siddiqui, Zishan; Melia, Michael T; Auwaerter, Paul G; Xu, Yanxun; Garibaldi, Brian T.
  • Ignatius EH; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Wang K; Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Karaba A; Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Robinson M; Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA.
  • Avery RK; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Blair P; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Chida N; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Jain T; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Petty BG; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Siddiqui Z; Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA.
  • Melia MT; Department of Pathology, Uniformed Services University, Bethesda, Maryland, USA.
  • Auwaerter PG; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Xu Y; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Garibaldi BT; Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis ; 8(1): ofaa598, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1062879
ABSTRACT

BACKGROUND:

There is currently no single treatment that mitigates all harms caused by severe acute respiratory syndrome coronavirus 2 infection. Tocilizumab, an interleukin-6 antagonist, may have a role as an adjunctive immune-modulating therapy.

METHODS:

This was an observational retrospective study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19). The intervention group comprised patients who received tocilizumab; the comparator arm was drawn from patients who did not receive tocilizumab. The primary outcome was all-cause mortality censored at 28 days; secondary outcomes were all-cause mortality at discharge, time to clinical improvement, and rates of secondary infections. Marginal structural Cox models via inverse probability treatment weights were applied to estimate the effect of tocilizumab. A time-dependent propensity score-matching method was used to generate a 11 match for tocilizumab recipients; infectious diseases experts then manually reviewed these matched charts to identify secondary infections.

RESULTS:

This analysis included 90 tocilizumab recipients and 1669 controls. Under the marginal structural Cox model, tocilizumab was associated with a 62% reduced hazard of death (adjusted hazard ratio [aHR], 0.38; 95% CI, 0.21 to 0.70) and no change in time to clinical improvement (aHR, 1.13; 95% CI, 0.68 to 1.87). The 11 matched data set also showed a lower mortality rate (27.8% vs 34.4%) and reduced hazards of death (aHR, 0.47; 95% CI, 0.25 to 0.88). Elevated inflammatory markers were associated with reduced hazards of death among tocilizumab recipients compared with controls. Secondary infection rates were similar between the 2 groups.

CONCLUSIONS:

Tocilizumab may provide benefit in a subgroup of patients hospitalized with COVID-19 who have elevated biomarkers of hyperinflammation, without increasing the risk of secondary infection.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Open Forum Infect Dis Year: 2021 Document Type: Article Affiliation country: Ofid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Open Forum Infect Dis Year: 2021 Document Type: Article Affiliation country: Ofid