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Tocilizumab efficacy in COVID-19 patients is associated with respiratory severity-based stages

Authors :
Instituto de Salud Carlos III
Comunidad de Madrid
Ministerio de Economía y Competitividad (España)
Ministerio de Ciencia e Innovación (España)
Álvarez-Mon, Melchor
Asúnsolo, Ángel
Sanz, José
Muñoz, Benjamin
Arranz-Caso, José Alberto
Novella Mena, Maria
Hernández-Gutiérrez, Cristina
Navarro, Jorge
Lozano Durán, María Cristina
Arévalo Serrano, Juan
Henche Sánchez, Rocío
Bravo Quiroga, Lara
Flores Segovia, Julio
García Sánchez, Marta
Gutiérrez García, Aida
Pérez, Ana
Herrero-Villar, Marta
Plana, Nieves
Troncoso, Daniel
Rackov, Gorjana
Martínez-A, Carlos
Balomenos, Dimitrios
Instituto de Salud Carlos III
Comunidad de Madrid
Ministerio de Economía y Competitividad (España)
Ministerio de Ciencia e Innovación (España)
Álvarez-Mon, Melchor
Asúnsolo, Ángel
Sanz, José
Muñoz, Benjamin
Arranz-Caso, José Alberto
Novella Mena, Maria
Hernández-Gutiérrez, Cristina
Navarro, Jorge
Lozano Durán, María Cristina
Arévalo Serrano, Juan
Henche Sánchez, Rocío
Bravo Quiroga, Lara
Flores Segovia, Julio
García Sánchez, Marta
Gutiérrez García, Aida
Pérez, Ana
Herrero-Villar, Marta
Plana, Nieves
Troncoso, Daniel
Rackov, Gorjana
Martínez-A, Carlos
Balomenos, Dimitrios
Publication Year :
2021

Abstract

Background Tocilizumab treatment is investigated, and effectiveness in ICU-admitted COVID-19 patients has been reported. Although controversy exists regarding the efficacy of tocilizumab treatment, it has been suggested that tocilizumab might show positive results depending on patient severity status. We examined an association between tocilizumab and distinct disease severity stages. Methods and Findings From March 3 to March 23 2020, 494 consecutively admitted COVID-19 patients received tocilizumab or standard treatment alone. Data were obtained retrospectively. Clinical respiratory severity (CRS) stages were defined by patient oxygenation status and were also associated to scores of WHO clinical progression scale. We categorized patients in three stages, mild/moderate CRS1 (FiSpO2<0.35; WHO score 5), moderate/severe CRS2 (FiO2=0.5/high flow mask; WHO score 6) and severe/critical CRS3 (FiO2<80%/high flow/prone position or mechanical ventilation; score>6). The primary outcome was the composite of death or ICU admission in patients of stages CRS1, CRS2, and CRS3, as well as in total patients. We also addressed mortality alone in total patients. Kaplan-Maier curves, Cox proportional regression and inverse probability weighting marginal structural models were used. We conducted the study from March 3 to April 7 2020 with broad-ranged severity patients; 167 tocilizumab-treated and 327 untreated. CRS1 patients showed no apparent benefit after treatment, while the risk of the primary outcome was greatly reduced in CRS2 treated participants ((HR=0.22; 95% CI (0.16-0.44)). Moreover, tocilizumab treatment was associated with significantly decreased CRS2 patient proportion that reached the outcome compared to non-treated controls (27.8.0% vs. 65.4%; p<0.001). Severe/critical CRS3 patients, also showed benefit after treatment (HR=0.38; 95% CI (0.16-90)), although not as robust as was that of CRS2 treated individuals. Tocilizumab was associated with reduced outcome risk in tot

Details

Database :
OAIster
Notes :
English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1286566720
Document Type :
Electronic Resource