tetano
Editor, Senior Moderator
Int J Infect Dis
. 2020 Jul 25;S1201-9712(20)30568-3.
doi: 10.1016/j.ijid.2020.07.023. Online ahead of print.
Early administration of Interleukin-6 inhibitors for patients with severe Covid-19 disease is associated with decreased intubation, reduced mortality, and increased discharge
Pranay Sinha[SUP] 1 [/SUP], Anahita Mostaghim[SUP] 2 [/SUP], Catherine G Bielick[SUP] 2 [/SUP], Angela McLaughlin[SUP] 1 [/SUP], Davidson H Hamer[SUP] 3 [/SUP], Lee Wetzler[SUP] 1 [/SUP], Nahid Bhadelia[SUP] 4 [/SUP], Maura Fagan[SUP] 1 [/SUP], Benjamin P Linas[SUP] 1 [/SUP], Sabrina A Assoumou[SUP] 1 [/SUP], Michael H Ieong[SUP] 5 [/SUP], Nina H Lin[SUP] 1 [/SUP], Ellen R Cooper[SUP] 6 [/SUP], Karrine D Brade[SUP] 7 [/SUP], Laura F White[SUP] 8 [/SUP], Tamar F Barlam[SUP] 1 [/SUP], Manish Sagar[SUP] 9 [/SUP], Boston Medical Center Covid-19, Treatment Panel
Affiliations
Abstract
Objective: This observational study aimed to determine optimal timing of interleukin-6 receptor inhibitors (IL6ri) administration for Coronavirus disease 2019 (Covid-19).
Methods: Patients with Covid-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into 2 groups: those requiring ≤ 45% fraction of inspired oxygen (FiO[SUB]2[/SUB]) (termed stage IIB) and those requiring >45% FiO[SUB]2[/SUB] (termed stage III) at the time of IL6ri administration. Main outcomes were all-cause mortality, discharge alive from hospital, and extubation.
Results: 255 Covid-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than the stage III group (adjusted hazard ratio [aHR]: 0.24; 95% confidence interval [CI] 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR: 1.43; 95% CI 1.06 - 1.93) and were less likely to be intubated (HR: 0.43; 95% CI: 0.24-0.79).
Conclusions: IL6ri administration prior to greater than 45% FiO[SUB]2[/SUB] requirement was associated with improved Covid-19 outcomes. This can guide clinical management pending results from randomized control trials.
Keywords: COVID-19; Cytokine release syndrome; Interleukin-6 inhibitors; Sarilumab; Tocilizumab.
. 2020 Jul 25;S1201-9712(20)30568-3.
doi: 10.1016/j.ijid.2020.07.023. Online ahead of print.
Early administration of Interleukin-6 inhibitors for patients with severe Covid-19 disease is associated with decreased intubation, reduced mortality, and increased discharge
Pranay Sinha[SUP] 1 [/SUP], Anahita Mostaghim[SUP] 2 [/SUP], Catherine G Bielick[SUP] 2 [/SUP], Angela McLaughlin[SUP] 1 [/SUP], Davidson H Hamer[SUP] 3 [/SUP], Lee Wetzler[SUP] 1 [/SUP], Nahid Bhadelia[SUP] 4 [/SUP], Maura Fagan[SUP] 1 [/SUP], Benjamin P Linas[SUP] 1 [/SUP], Sabrina A Assoumou[SUP] 1 [/SUP], Michael H Ieong[SUP] 5 [/SUP], Nina H Lin[SUP] 1 [/SUP], Ellen R Cooper[SUP] 6 [/SUP], Karrine D Brade[SUP] 7 [/SUP], Laura F White[SUP] 8 [/SUP], Tamar F Barlam[SUP] 1 [/SUP], Manish Sagar[SUP] 9 [/SUP], Boston Medical Center Covid-19, Treatment Panel
Affiliations
- PMID: 32721528
- DOI: 10.1016/j.ijid.2020.07.023
Abstract
Objective: This observational study aimed to determine optimal timing of interleukin-6 receptor inhibitors (IL6ri) administration for Coronavirus disease 2019 (Covid-19).
Methods: Patients with Covid-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into 2 groups: those requiring ≤ 45% fraction of inspired oxygen (FiO[SUB]2[/SUB]) (termed stage IIB) and those requiring >45% FiO[SUB]2[/SUB] (termed stage III) at the time of IL6ri administration. Main outcomes were all-cause mortality, discharge alive from hospital, and extubation.
Results: 255 Covid-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than the stage III group (adjusted hazard ratio [aHR]: 0.24; 95% confidence interval [CI] 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR: 1.43; 95% CI 1.06 - 1.93) and were less likely to be intubated (HR: 0.43; 95% CI: 0.24-0.79).
Conclusions: IL6ri administration prior to greater than 45% FiO[SUB]2[/SUB] requirement was associated with improved Covid-19 outcomes. This can guide clinical management pending results from randomized control trials.
Keywords: COVID-19; Cytokine release syndrome; Interleukin-6 inhibitors; Sarilumab; Tocilizumab.