Tocilizumab for the Treatment of COVID-19 Among Hospitalized Patients: A Matched Retrospective Cohort Analysis. (28th December 2020)

• Record Type: Journal Article
• Authors: Ignatius, Elisa H; Wang, Kunbo; Karaba, Andrew; Robinson, Matthew; Avery, Robin K; Blair, Paul; Chida, Natasha; Jain, Tania; Petty, Brent G; Siddiqui, Zishan; Melia, Michael T; Auwaerter, Paul G; Xu, Yanxun; Garibaldi, Brian T
• Is Part Of: Open forum infectious diseases. Volume 8:Number 1(2021)
• Publication Date: 2020-12-28
• Subjects: COVID-19 -- IL-6 -- SARS-CoV-2 -- retrospective -- tocilizumab; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa598
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: There is currently no single treatment that mitigates all harms caused by severe acute respiratory syndrome coronavirus 2 infection. Tocilizumab, an interleukin-6 antagonist, may have a role as an adjunctive immune-modulating therapy. Methods: This was an observational retrospective study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19). The intervention group comprised patients who received tocilizumab; the comparator arm was drawn from patients who did not receive tocilizumab. The primary outcome was all-cause mortality censored at 28 days; secondary outcomes were all-cause mortality at discharge, time to clinical improvement, and rates of secondary infections. Marginal structural Cox models via inverse probability treatment weights were applied to estimate the effect of tocilizumab. A time-dependent propensity score–matching method was used to generate a 1:1 match for tocilizumab recipients; infectious diseases experts then manually reviewed these matched charts to identify secondary infections. Results: This analysis included 90 tocilizumab recipients and 1669 controls. Under the marginal structural Cox model, tocilizumab was associated with a 62% reduced hazard of death (adjusted hazard ratio [aHR], 0.38; 95% CI, 0.21 to 0.70) and no change in time to clinical improvement (aHR, 1.13; 95% CI, 0.68 to 1.87). The 1:1 matched data set also showed a lower mortality rate (27.8% vs 34.4%) and reduced hazards of death (aHR, 0.47; 95% CI, 0.25 to 0.88). Elevated inflammatory markers were associated with reduced hazards of death among tocilizumab recipients compared with controls. Secondary infection rates were similar between the 2 groups. Conclusions: Tocilizumab may provide benefit in a subgroup of patients hospitalized with COVID-19 who have elevated biomarkers of hyperinflammation, without increasing the risk of secondary infection. Abstract : In this retrospective study of adult patients hospitalized with COVID-19, tocilizumab was associated with a 62% reduction in hazard of death. Tocilizumab may have a role as adjunctive therapy for COVID-19 among patients with hyperinflammation including elevated IL-6.