09.05.2020

Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients

Therapeutic InfectiologyPulmonologyAnesthesia-intensive care
Klopfenstein T et al
Médecine et Maladies Infectieuses

Main result

  • 20 patients included in the "standard treatment + tocilizumab" group and 25 in the "standard treatment only" group.
  • The two groups were comparable in terms of age, gender, and clinical parameters at admission. However, patients in the tocilizumab group appeared to be at greater risk of bad outcomes and more critical:
  • higher Charlson's co-morbidity score; more intense and prolonged oxygen therapy during hospitalization: 13 L/min versus 6 L/min and 12 days versus 4 days; higher lymphopenia and higher CRP on admission.
  • Intensive care admissions and/or deaths were more frequent in the "standard treatment only" group than in the "tocilizumab" group: 72% versus 25%, p=0.002. Similarly, patients not treated with tocilizumab appeared more likely to be treated with invasive mechanical ventilation: 32% versus 0%, p=0.006. Tendency to lower lethality in the tocilizumab group was not statistically significant.

Takeaways

This study demonstrates the potential efficacy of tocilizumab in improving the progression of COVID-19 in hospitalized, oxygen-requiring patients by reducing the number of intensive care admissions and deaths. However, no recommendation can be derived from this study alone and this drug should be investigated in studies with a higher standard of proof.

Strength of evidence Weak

- Retrospective study
- Small population
- No information concerning the comparability of the groups in terms of antiviral treatment of the so-called "standard" treatment received: is there the same use of hydroxychloroquine and lopinavir/ritonavir between the two groups?

Objectives

Compare the evolution of COVID-19 between patients treated and untreated with tocilizumab.

Method

Monocentric comparative retrospective study with descriptive purpose. Tocilizumab is a humanized monoclonal antibody to the IL-6 receptor and is generally prescribed for rheumatoid arthritis.

Inclusion criteria: COVID-19 confirmed patients with RT-PCR who require oxygen therapy.

Exclusion criteria: Patients with non-routine therapy (remdesivir, immunoglobulins).

All received standard treatment: hydroxychloroquine or lopinavir/ritonavir; antibiotics; sometimes corticosteroids.

Comparison of two groups :
standard treatment only (03/01/2020 to 03/18/2020)
standard treatment + tocilizumab (01/04/2020 to 13/04/2020) :
patients without contraindications to tocilizumab
standard treatment failure
onset of symptoms more than 7 days ago
Oxygen therapy flow rate 5 L/min
on a thoracic CT scan 25% of the affected lungs
at least 2 biological parameters of high inflammation and severity (ferritin, CRP, D-dimers, lymphopenia, LDH)

Primary assessment criterion: admission to intensive care and/or death.

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