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Tocilizumab for the treatment of adult patients with severe COVID‐19 pneumonia: A single‐center cohort study
Author(s) -
FernándezRuiz Mario,
LópezMedrano Francisco,
PérezJacoiste Asín María Asunción,
Maestro de la Calle Guillermo,
Bueno Héctor,
CaroTeller José Manuel,
Catalán Mercedes,
Calle Cristina,
GarcíaGarcía Rocío,
Gómez Carlos,
LagunaGoya Rocío,
Lizasoáin Manuel,
MartínezLópez Joaquín,
Origüen Julia,
Pablos José Luis,
Ripoll Mar,
San Juan Rafael,
Trujillo Hernando,
Lumbreras Carlos,
Aguado José María
Publication year - 2021
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.26308
Subject(s) - medicine , tocilizumab , odds ratio , pneumonia , confidence interval , clinical endpoint , adverse effect , retrospective cohort study , gastroenterology , clinical trial , rheumatoid arthritis
Coronavirus disease 2019 (COVID‐19) can lead to a massive cytokine release. The use of the anti‐interleukin‐6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID‐19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6‐point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6‐point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon‐β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06‐0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06‐0.99; P = .048) were negatively associated with clinical improvement by day 7. All‐cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO 2 ratio increased by days 3 and 5, whereas C‐reactive protein levels dropped by day 2. There were no TCZ‐attributable adverse events. In this observational single‐center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID‐19 pneumonia.