Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study

被引：207

作者：

Biran, Noa ^{[2
]}

Ip, Andrew ^{[1
]}

Ahn, Jaeil ^{[4
]}

Go, Ronaldo C. ^{[3
]}

Wang, Shuqi ^{[4
]}

Mathura, Shivam ^{[6
]}

Sinclaire, Brittany A. ^{[2
]}

Bednarz, Urszula ^{[2
]}

Marafelias, Michael ^{[2
]}

Hansen, Eric ^{[6
]}

Siegel, David S. ^{[2
]}

Goy, Andre H. ^{[2
]}

Pecora, Andrew L. ^{[2
]}

Sawczuk, Ihor S. ^{[5
]}

Koniaris, Lauren S. ^{[3
]}

Simwenyi, Micky ^{[3
]}

Varga, Daniel W. ^{[3
]}

Tank, Lisa K. ^{[3
]}

Stein, Aaron A. ^{[7
]}

Allusson, Valerie ^{[8
]}

Lin, George S. ^{[9
]}

Oser, William F. ^{[10
]}

Tuma, Roman A. ^{[11
]}

Reichman, Joseph ^{[12
]}

Brusco, Louis, Jr. ^{[13
,14
]}

Carpenter, Kim L. ^{[15
]}

Costanzo, Eric J. ^{[15
]}

Vivona, Vincent ^{[16
,17
]}

Goldberg, Stuart L. ^{[1
]}

机构：

[1] Div Outcomes & Value Res, Hackensack, NJ USA

[2] John Theurer Canc Ctr, Hackensack, NJ USA

[3] Hackensack Univ, Med Ctr, Hackensack, NJ 07601 USA

[4] Georgetown Univ, Dept Biostat Bioinformat & Biomath, Washington, DC USA

[5] Hackensack Univ, Med Ctr, Hackensack Meridian Hlth Sch Med, Seton Hall Univ, Nutley, NJ USA

[6] COTA, Boston, MA USA

[7] Palisades Med Ctr, North Bergen, NJ USA

[8] Mountainside Med Ctr, Glen Ridge, NJ USA

[9] Pascack Valley Med Ctr, Westwood, NJ USA

[10] JFK Med Ctr, Edison, NJ USA

[11] Bayshore Med Ctr, Holmdel, NJ USA

[12] Riverview Med Ctr, Red Bank, NJ USA

[13] Raritan Bay Med Ctr, Old Bridge, NJ USA

[14] Raritan Bay Med Ctr, Perth Amboy, NJ USA

[15] Jersey Shore Univ, Med Ctr, Neptune, NJ USA

[16] Ocean Med Ctr, Brick Township, NJ USA

[17] Southern Ocean Med Ctr, Stafford Township, NJ USA

来源：

LANCET RHEUMATOLOGY | 2020年 / 2卷 / 10期

关键词：

D O I：

10.1016/S2665-9913(20)30277-0

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed to mitigate the cytokine storm syndrome associated with severe COVID-19. We aimed to investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19. Methods We did a retrospective observational cohort study at 13 hospitals within the Hackensack Meridian Health network (NJ, USA). We included patients (aged >= 18 years) with laboratory-confirmed COVID-19 who needed support in the ICU. We obtained data from a prospective observational database and compared outcomes in patients who received tocilizumab with those who did not. We applied a multivariable Cox model with propensity score matching to reduce confounding effects. The primary endpoint was hospital-related mortality. The prospective observational database is registered on ClinicalTrials.gov, NCT04347993. Findings Between March 1 and April 22, 2020, 764 patients with COVID-19 required support in the ICU, of whom 210 (27%) received tocilizumab. Factors associated with receiving tocilizumab were patients' age, gender, renal function, and treatment location. 630 patients were included in the propensity score-matched population, of whom 210 received tocilizumab and 420 did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. Overall median survival from time of admission was not reached (95% CI 23 days-not reached) among patients receiving tocilizumab and was 19 days (16-26) for those who did not receive tocilizumab (hazard ratio [HR] 0.71, 95% CI 0.56-0.89; p=0.0027). In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (HR 0.64, 95% CI 0.47-0.87; p=0.0040). Similar associations with tocilizumab were noted among subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg/dL or higher. Interpretation In this observational study, patients with COVID-19 requiring ICU support who received tocilizumab had reduced mortality. Results of ongoing randomised controlled trials are awaited.

引用

页码：E603 / E612

页数：10

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