About: Tocilizumab for treatment of mechanically ventilated patients with COVID-19

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An Entity of Type : schema:ScholarlyArticle, within Data Space : covidontheweb.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Tocilizumab for treatment of mechanically ventilated patients with COVID-19
Creator	Wang, Lu Martin, Emily Gregg, Kevin Lauring, Adam Petty, Lindsay Baang, Ji Dillman, Nicholas Eschenauer, Gregory Frame, David Fung, Christopher Gandhi, Tejal Golob, Jonathan Hanauer, David Kaul, Dan Nagel, Jerod Patel, Twisha Pogue, Jason Sharma, Pratima Somers, Emily Troost, Jonathan Zhou, Nina Zhou, Shiwei
source	MedRxiv; Medline; PMC
abstract	BACKGROUND: Severe COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers. This presentation is consistent with cytokine release syndrome in chimeric antigen receptor T cell therapy, for which IL-6 blockade is approved treatment. METHODS: We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability post-intubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared to tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability weighting (IPTW). FINDINGS: 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.59 (0.36, 0.95)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; p<0.001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection [22% vs. 15%; p=0.42]. INTERPRETATION: In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with a decreased likelihood of death despite higher superinfection occurrence. Randomized controlled trials are urgently needed to confirm these findings.
has issue date	2020-06-03(xsd:dateTime)
bibo:doi	10.1101/2020.05.29.20117358
bibo:pmid	32577684
has license	cc-by-nc-nd
sha1sum (hex)	e21110897edb050a8a7efcccc2bc4b21a12db942
schema:url	https://doi.org/10.1101/2020.05.29.20117358
resource representing a document's title	Tocilizumab for treatment of mechanically ventilated patients with COVID-19
has PubMed Central identifier	PMC7302290
has PubMed identifier	32577684
schema:publication	medRxiv
resource representing a document's body	covid:e21110897edb050a8a7efcccc2bc4b21a12db942#body_text
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