Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19. (April 2022)

• Record Type: Journal Article
• Authors: San-Juan, Rafael; Fernández-Ruiz, Mario; López-Medrano, Francisco; Carretero, Octavio; Lalueza, Antonio; Maestro de la Calle, Guillermo; Pérez-Jacoiste Asín, María Asunción; Bueno, Héctor; Caro-Teller, José Manuel; Catalán, Mercedes; de la Calle, Cristina; García-García, Rocío; Gómez, Carlos; Laguna-Goya, Rocío; Lizasoáin, Manuel; Martínez-López, Joaquín; Origüen, Julia; Sevillano, Ángel; Gutiérrez, Eduardo; de Miguel, Borja; Aguilar, Fernando; Parra, Patricia; Ripoll, Mar; Ruiz-Merlo, Tamara; Trujillo, Hernando; Pablos, José Luis; Paz-Artal, Estela; Lumbreras, Carlos; Aguado, José María
• Is Part Of: International journal of infectious diseases. Volume 117(2022)
• Page Start: 56
• Page End: 64
• Publication Date: 2022-04
• Subjects: COVID-19 -- tocilizumab -- clinical response -- predictors -- early initiation; ALT alanine transaminase -- ARDS acute respiratory distress syndrome -- AST aspartate transaminase -- COVID-19 coronavirus disease 2019 -- CRP C-reactive protein -- ePO2/FiO2 estimated arterial oxygen/fraction of inspired oxygen ratio -- HCQ hydroxychloroquine -- ICU intensive care unit -- IFN-β interferon-β -- IQR interquartile range -- IL-6 interleukin-6 -- IMV invasive mechanical ventilation -- LDH lactate dehydrogenase -- LPV/r lopinavir/ritonavir -- NAT nucleic acid testing -- OTR oxygen therapy requirements -- SCI Significant clinical improvement -- RT-PCR reverse transcription-polymerase chain reaction -- SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 -- TCZ tocilizumab; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.01.040
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Improvement at 14 days occurs in 63.3% of severe COVID-19 treated with tocilizumab. Early administration of tocilizumab is associated with better clinical response. A recruitment window of 48 hours from admission in tocilizumab randomized clinical trials is advisable. Abstract: Background: Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients. Methods: We retrospectively analyzed a cohort of patients with severe COVID-19 who received off-label TCZ after recommendation by a local committee and were admitted to the University Hospital "12 de Octubre" until May 2020. The primary end point was a significant clinical improvement (SCI) on day 14 after administration of TCZ. Factors independently related to SCI were analyzed by multivariate logistic regression models. Results: Of 428 (63.3%) patients treated with TCZ, 271 (63.3%) experienced SCI. After adjustment for factors related to unfavorable outcomes, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1–3.55; P = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI: 1.3–8.1; P = 0.01) were independently related to SCI. The rate of SCI significantly decreased according to the time of TCZ administration: 70.2% in the first 48 hours from admission, 58.5% on days 3-7, and 45.1% after day 7 ( P = 0.03 and P = 0.001, respectively). Conclusion: TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission.