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Impact of Timing of Tocilizumab Use in Hospitalized Patients With SARS-CoV-2 Infection.
Singh, Anup K; Oks, Margarita; Husk, Gregg; Dechario, Samuel P; Mina, Bushra; Singh, Kanwaljit; Kirschenbaum, Linda; Carpati, Charles M; Mahmoud, Omar; Gabra, Nader Ishak; Ishikawa, Oki; Altschultz, Erica; Shah, Varun; Mahajan, Akhilesh; Gautam, Arun; Birnbaum, Brian; Antonacci, Anthony C; Raoof, Suhail.
  • Singh AK; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York. asingh21@northwell.edu.
  • Oks M; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Husk G; Hospital Administration, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Dechario SP; Department of Surgery, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Mina B; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Singh K; Critical Path Institute - International Neonatal Consortium, Tucson, Arizona.
  • Kirschenbaum L; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Carpati CM; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Mahmoud O; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Gabra NI; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Ishikawa O; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Altschultz E; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Shah V; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Mahajan A; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Gautam A; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Birnbaum B; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Antonacci AC; Department of Surgery, Lenox Hill Hospital - Northwell Health System, New York, New York.
  • Raoof S; Department of Pulmonary Critical Care and Sleep Medicine, Lenox Hill Hospital - Northwell Health System, New York, New York.
Respir Care ; 66(12): 1805-1814, 2021 12.
Article in English | MEDLINE | ID: covidwho-1436179
ABSTRACT

BACKGROUND:

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) continues to be a global challenge due to the lack of definitive treatment strategies. We sought to determine the efficacy of early administration of anti-interleukin 6 therapy in reducing hospital mortality and progression to mechanical ventilation.

METHODS:

This was a retrospective chart review of 11,512 patients infected with SARS-CoV-2 who were admitted to a New York health system from March to May 2020. Tocilizumab was administered to subjects at the nasal cannula level of oxygen support to maintain an oxygen saturation of >88%. The Charlson comorbidity index was used as an objective assessment of the burden of comorbidities to predict 10-year mortality. The primary outcome of interest was hospital mortality. Secondary outcomes were progression to mechanical ventilation; the prevalence of venous thromboembolism and renal failure; and the change in C-reactive protein, D-dimer, and ferritin levels after tocilizumab administration. Propensity score matching by using a 12 protocol was used to match the tocilizumab and non-tocilizumab groups to minimize selection bias. The groups were matched on baseline demographic characteristics, including age, sex, and body mass index; Charlson comorbidity index score; laboratory markers, including ferritin, D-dimer, lactate dehydrogenase, and C-reactive protein values; and the maximum oxygen requirement at the time of tocilizumab administration. Mortality outcomes were evaluated based on the level of oxygen requirement and the day of hospitalization at the time of tocilizumab administration.

RESULTS:

The overall hospital mortality was significantly reduced in the tocilizumab group when tocilizumab was administered at the nasal cannula level (10.4% vs 22.0%; P = .002). In subjects who received tocilizumab at the nasal cannula level, the progression to mechanical ventilation was reduced versus subjects who were initially on higher levels of oxygen support (6.3% vs 18.7%; P < .001). There was no improvement in mortality when tocilizumab was given at the time of requiring non-rebreather, high-flow nasal cannula, noninvasive ventilator, or invasive ventilator.

CONCLUSIONS:

Early use of anti-interleukin 6 therapy may be associated with improved hospital mortality and reduction in progression to more severe coronavirus disease 2019.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Respir Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Respir Care Year: 2021 Document Type: Article