1. What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak.
- Author
-
Mehta M, Purpura LJ, McConville TH, Neidell MJ, Anderson MR, Bernstein EJ, Dietz DE, Laracy J, Gunaratne SH, Miller EH, Cheng J, Zucker J, Shah SS, Chaudhuri S, Gordillo CA, Patel SR, Guo TW, Karaaslan LE, Reshef R, Miko BA, Bathon JM, Pereira MR, Uhlemann AC, Yin MT, and Sobieszczyk ME
- Subjects
- Antibodies, Monoclonal, Humanized adverse effects, Disease-Free Survival, Female, Humans, Male, Middle Aged, New York City epidemiology, Respiration, Artificial, Retrospective Studies, Survival Rate, Antibodies, Monoclonal, Humanized administration & dosage, Bacterial Infections etiology, Bacterial Infections mortality, COVID-19 mortality, Disease Outbreaks, Hospitals, Teaching, SARS-CoV-2, COVID-19 Drug Treatment
- Abstract
Background: Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease., Methods: In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test., Results: We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168)., Conclusions: There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab., Competing Interests: There are no conflict of interests to declare authors, except Anne-Catrin Uhlemann, MD, PhD has previously received NIH grant support rom Allergan, GSK and Merck unrelated to this project. Joan Bathon, MD has participated in, and been reimbursed for, a grant review panel for Gilead Sciences, unrelated to this project. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
- Published
- 2021
- Full Text
- View/download PDF