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Tocilizumab in the Management of COVID-19: A Preliminary Report.
Li, Michael; Yoo, Erika J; Baram, Michael; McArthur, Melanie; Skeehan, Connor; Awsare, Bharat; George, Gautam; Summer, Ross; Zurlo, John; Jallo, Jack; Roman, Jesse.
  • Li M; Enterprise Analytics, Jefferson Health.
  • Yoo EJ; Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health.
  • Baram M; Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health.
  • McArthur M; Enterprise Analytics, Jefferson Health.
  • Skeehan C; Enterprise Analytics, Jefferson Health.
  • Awsare B; Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health.
  • George G; Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health.
  • Summer R; Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine; Jane & Leonard Korman Respiratory Institute, Jefferson Health.
  • Zurlo J; Division of Infectious Diseases, Sidney Kimmel College of Medicine.
  • Jallo J; Department of Neurosurgery; Thomas Jefferson University, Philadelphia, PA, United States.
  • Roman J; Enterprise Analytics, Jefferson Health; Jane & Leonard Korman Respiratory Institute, Jefferson Health. Electronic address: jesse.roman@jefferson.edu.
Am J Med Sci ; 361(2): 208-215, 2021 02.
Article in English | MEDLINE | ID: covidwho-1064783
ABSTRACT
IMPORTANCE Pneumonia due to COVID-19 can lead to respiratory failure and death due to the development of the acute respiratory distress syndrome. Tocilizumab, a monoclonal antibody targeting the interleukin-6 receptor, is being administered off-label to some patients with COVID-19, and although early small studies suggested a benefit, there are no conclusive data proving its usefulness.

OBJECTIVE:

To evaluate outcomes in hospitalized patients with COVID-19 with or without treatment with Tocilizumab. DESIGN, SETTING,

PARTICIPANTS:

Retrospective study of 1938 patients with confirmed COVID-19 pneumonia admitted to hospitals within the Jefferson Health system in Philadelphia, Pennsylvania, between March 25, 2020 and June 17, 2020, of which 307 received Tocilizumab. EXPOSURES Confirmed COVID-19 pneumonia. MAIN OUTCOMES AND

MEASURES:

Outcomes data related to length of stay, admission to intensive care unit (ICU), requirement of mechanical ventilation, and mortality were collected and analyzed.

RESULTS:

The average age was 65.2, with 47% women; 36.4% were African-American. The average length of stay was 22 days with 26.3% of patients requiring admission to the ICU and 14.9% requiring mechanical ventilation. The overall mortality was 15.3%. Older age, admission to an ICU, and requirement for mechanical ventilation were associated with higher mortality. Treatment with Tocilizumab was also associated with higher mortality, which was mainly observed in subjects not requiring care in an ICU with estimated odds ratio (OR) of 2.9 (p = 0.0004). Tocilizumab treatment was also associated with higher likelihood of admission to an ICU (OR = 4.8, p < 0.0001), progression to requiring mechanical ventilation (OR = 6.6, p < 0.0001), and increased length of stay (OR = 16.2, p < 0.0001). CONCLUSION AND RELEVANCE Our retrospective analysis revealed an association between Tocilizumab administration and increased mortality, ICU admission, mechanical ventilation, and length of stay in subjects with COVID-19. Prospective trials are needed to evaluate the true effect of Tocilizumab in this condition.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Management / Antibodies, Monoclonal, Humanized / COVID-19 Drug Treatment Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Am J Med Sci Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Management / Antibodies, Monoclonal, Humanized / COVID-19 Drug Treatment Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Am J Med Sci Year: 2021 Document Type: Article