tetano
Editor, Senior Moderator
Rheumatol Int
. 2021 Sep 13.
doi: 10.1007/s00296-021-04965-6. Online ahead of print.
Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls
Ali Mert[SUP] 1 [/SUP], Haluk Vahaboğlu[SUP] 2 [/SUP], Ferhat Arslan[SUP] 2 [/SUP], Ayşe Batirel[SUP] 3 [/SUP], Kemal Tolga Saraçoğlu[SUP] 3 [/SUP], Aliye Bastug[SUP] 4 [/SUP], Atahan Çağatay[SUP] 5 [/SUP], İlim Irmak[SUP] 6 [/SUP], Gülçin Telli Dizman[SUP] 6 [/SUP], İhsan Ertenli[SUP] 6 [/SUP], Lütfiye Nilsun Altunal[SUP] 7 [/SUP], Buket Ertürk Sengel[SUP] 8 [/SUP], Mehmet Bayram[SUP] 1 [/SUP], Ahmet Omma[SUP] 4 [/SUP], Shirkhan Amikishiyev[SUP] 5 [/SUP], Adalet Aypak[SUP] 4 [/SUP], Cemal Bes[SUP] 9 [/SUP], Sibel Bolukçu[SUP] 10 [/SUP], Sacit Içten[SUP] 2 [/SUP], Arzu Topeli[SUP] 6 [/SUP], Murat Bektaş[SUP] 5 [/SUP], Birsen Yiğit Arslan[SUP] 7 [/SUP], Sinan Öztürk[SUP] 7 [/SUP], Şenol Çomoğlu[SUP] 7 [/SUP], Selda Aydin[SUP] 1 [/SUP], Orhan Küçükşahin[SUP] 11 [/SUP], Ozan Cemal Içaçan[SUP] 9 [/SUP], Burak Ince[SUP] 5 [/SUP], Sarvan Aghamuradov[SUP] 5 [/SUP], Melek Yalçin Mutlu[SUP] 9 [/SUP], Funda Şimşek[SUP] 12 [/SUP], Salih Emre[SUP] 12 [/SUP], Cemal Ustun[SUP] 13 [/SUP], Pinar Ergen[SUP] 2 [/SUP], Özlem Aydin[SUP] 2 [/SUP], Meliha Meriç Koç[SUP] 10 [/SUP], Ömür Gökmen Sevindik[SUP] 1 [/SUP], Zekaver Odabaşı[SUP] 8 [/SUP], Volkan Korten[SUP] 8 [/SUP], Hurrem Bodur[SUP] 4 [/SUP], Rahmet Güner[SUP] 11 [/SUP], Serhat Ünal[SUP] 6 [/SUP], Mehmet Kocak[SUP] 1 [/SUP], Ahmet Gül[SUP] 14 [/SUP]
Affiliations
Abstract
Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.
Keywords: Acute respiratory distress syndrome; COVID-19; Cytokine storm; Interleukin-6 (IL-6); Macrophage activation syndrome; Pneumonia; Tocilizumab.
. 2021 Sep 13.
doi: 10.1007/s00296-021-04965-6. Online ahead of print.
Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls
Ali Mert[SUP] 1 [/SUP], Haluk Vahaboğlu[SUP] 2 [/SUP], Ferhat Arslan[SUP] 2 [/SUP], Ayşe Batirel[SUP] 3 [/SUP], Kemal Tolga Saraçoğlu[SUP] 3 [/SUP], Aliye Bastug[SUP] 4 [/SUP], Atahan Çağatay[SUP] 5 [/SUP], İlim Irmak[SUP] 6 [/SUP], Gülçin Telli Dizman[SUP] 6 [/SUP], İhsan Ertenli[SUP] 6 [/SUP], Lütfiye Nilsun Altunal[SUP] 7 [/SUP], Buket Ertürk Sengel[SUP] 8 [/SUP], Mehmet Bayram[SUP] 1 [/SUP], Ahmet Omma[SUP] 4 [/SUP], Shirkhan Amikishiyev[SUP] 5 [/SUP], Adalet Aypak[SUP] 4 [/SUP], Cemal Bes[SUP] 9 [/SUP], Sibel Bolukçu[SUP] 10 [/SUP], Sacit Içten[SUP] 2 [/SUP], Arzu Topeli[SUP] 6 [/SUP], Murat Bektaş[SUP] 5 [/SUP], Birsen Yiğit Arslan[SUP] 7 [/SUP], Sinan Öztürk[SUP] 7 [/SUP], Şenol Çomoğlu[SUP] 7 [/SUP], Selda Aydin[SUP] 1 [/SUP], Orhan Küçükşahin[SUP] 11 [/SUP], Ozan Cemal Içaçan[SUP] 9 [/SUP], Burak Ince[SUP] 5 [/SUP], Sarvan Aghamuradov[SUP] 5 [/SUP], Melek Yalçin Mutlu[SUP] 9 [/SUP], Funda Şimşek[SUP] 12 [/SUP], Salih Emre[SUP] 12 [/SUP], Cemal Ustun[SUP] 13 [/SUP], Pinar Ergen[SUP] 2 [/SUP], Özlem Aydin[SUP] 2 [/SUP], Meliha Meriç Koç[SUP] 10 [/SUP], Ömür Gökmen Sevindik[SUP] 1 [/SUP], Zekaver Odabaşı[SUP] 8 [/SUP], Volkan Korten[SUP] 8 [/SUP], Hurrem Bodur[SUP] 4 [/SUP], Rahmet Güner[SUP] 11 [/SUP], Serhat Ünal[SUP] 6 [/SUP], Mehmet Kocak[SUP] 1 [/SUP], Ahmet Gül[SUP] 14 [/SUP]
Affiliations
- PMID: 34515808
- DOI: 10.1007/s00296-021-04965-6
Abstract
Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.
Keywords: Acute respiratory distress syndrome; COVID-19; Cytokine storm; Interleukin-6 (IL-6); Macrophage activation syndrome; Pneumonia; Tocilizumab.