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Interleukin-6 receptor blocking with intravenous tocilizumab in COVID-19 severe acute respiratory distress syndrome: A retrospective case-control survival analysis of 128 patients.

Authors
  • Canziani, Lorenzo M1
  • Trovati, Serena2
  • Brunetta, Enrico3
  • Testa, Amidio2
  • De Santis, Maria4
  • Bombardieri, Emilio5
  • Guidelli, Giacomo4
  • Albano, Giovanni6
  • Folci, Marco7
  • Squadroni, Michela8
  • Beretta, Giordano D8
  • Ciccarelli, Michele9
  • Castoldi, Massimo10
  • Lleo, Ana11
  • Aghemo, Alessio11
  • Vernile, Laura12
  • Malesci, Alberto13
  • Omodei, Paolo14
  • Angelini, Claudio3
  • Badalamenti, Salvatore3
  • And 3 more
  • 1 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; Internal Medicine, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 2 Internal Medicine, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 3 General Medicine and Nephrology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 4 Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 5 Scientific Direction, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 6 Anesthesiology and Intensive Care, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 7 General Medicine and Hepatology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 8 Medical Oncology, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 9 General Medicine and Pulmonology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 10 Medical Direction, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 11 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; General Medicine and Hepatology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 12 Pharmacy, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 13 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; General Medicine and Gastroenterology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 14 General Medicine and Gastroenterology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. , (Italy)
  • 15 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; Anesthesiology andIntensive Care, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. Electronic address: [email protected] , (Italy)
  • 16 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; Cardiology, Humanitas Gavazzeni, Bergamo (BG), Italy. , (Italy)
  • 17 Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy; Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy. Electronic address: [email protected] , (Italy)
Type
Published Article
Journal
Journal of Autoimmunity
Publisher
Elsevier
Publication Date
Nov 01, 2020
Volume
114
Pages
102511–102511
Identifiers
DOI: 10.1016/j.jaut.2020.102511
PMID: 32713677
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In cases of COVID-19 acute respiratory distress syndrome, an excessive host inflammatory response has been reported, with elevated serum interleukin-6 levels. In this multicenter retrospective cohort study we included adult patients with COVID-19, need of respiratory support, and elevated C-reactive protein who received intravenous tocilizumab in addition to standard of care. Control patients not receiving tocilizumab were matched for sex, age and respiratory support. We selected survival as the primary endpoint, along with need for invasive ventilation, thrombosis, hemorrhage, and infections as secondary endpoints at 30 days. We included 64 patients with COVID-19 in the tocilizumab group and 64 matched controls. At baseline the tocilizumab group had longer symptom duration (13 ± 5 vs. 9 ± 5 days) and received hydroxychloroquine more often than controls (100% vs. 81%). The mortality rate was similar between groups (27% with tocilizumab vs. 38%) and at multivariable analysis risk of death was not significantly influenced by tocilizumab (hazard ratio 0.61, 95% confidence interval 0.33-1.15), while being associated with the use at baseline of non invasive mechanical or invasive ventilation, and the presence of comorbidities. Among secondary outcomes, tocilizumab was associated with a lower probability of requiring invasive ventilation (hazard ratio 0.36, 95% confidence interval 0.16-0.83; P = 0.017) but not with the risk of thrombosis, bleeding, or infections. The use of intravenous tocilizumab was not associated with changes in 30-day mortality in patients with COVID-19 severe respiratory impairment. Among the secondary outcomes there was less use of invasive ventilation in the tocilizumab group. Copyright © 2020 Elsevier Ltd. All rights reserved.

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