Robert Wood Johnson University Hospital Somerset, 110 Rehill Avenue, Somerville, NJ, 08876, USA.
IDCare, 105 Raider Blvd, Hillsborough, NJ, 08844, USA.
Sci Rep. 2020 Nov 5;10(1):19131. doi: 10.1038/s41598-020-76187-y.
The novel coronavirus disease 2019 (COVID-19) worldwide pandemic has placed a significant burden on hospitals and healthcare providers. The immune response to this disease is thought to lead to an aberrant inflammatory response or cytokine storm, which contributes to the severity of illness. There is an urgent need to confirm whether the use of tocilizumab provides a benefit in individuals with COVID-19. A single-center propensity-score matched cohort study, including all consecutive COVID-19 patients, admitted to the medical center who were either discharged from the medical center or expired between March 1, 2020, and May 5, 2020, was performed. Patients were stratified according to the receipt of tocilizumab for cytokine storm and matched to controls using propensity scores. The primary outcome was in-hospital mortality. A total of 274 patients meeting inclusion and exclusion criteria were identified and 132 patients were included in the matched dataset (tocilizumab = 66; no tocilizumab = 66). Approximately 73% of the patients were male. Hypertension (55%), diabetes mellitus (31%), and chronic pulmonary disease (15%) were the most common comorbidities present. There were 18 deaths (27.3%) in the tocilizumab group and 18 deaths (27.3%) in the no tocilizumab group (odds ratio, 1.0; 95% confidence interval, 0.465 - 2.151; p = 1.00). Advanced age, history of myocardial infarction, dementia, chronic pulmonary disease, heart failure, and malignancy were significantly more common in patients who died. The current analysis does not support the use of tocilizumab for the management of cytokine storm in patients with COVID-19. Use of this therapeutic agent should be limited to the context of a clinical trial until more evidence is available.
2019 年新型冠状病毒病（COVID-19）全球大流行给医院和医疗保健提供者带来了巨大负担。据认为，这种疾病的免疫反应导致异常的炎症反应或细胞因子风暴，从而导致疾病的严重程度。目前迫切需要确认托珠单抗是否对 COVID-19 患者有益。对 2020 年 3 月 1 日至 5 月 5 日期间因 COVID-19 入住医疗中心的所有连续患者进行了一项单中心倾向评分匹配队列研究，这些患者或从医疗中心出院或死亡。根据细胞因子风暴是否接受托珠单抗治疗将患者分层，并使用倾向评分与对照组进行匹配。主要结局是住院死亡率。确定符合纳入和排除标准的 274 例患者，其中 132 例纳入匹配数据集（托珠单抗组=66 例；无托珠单抗组=66 例）。大约 73%的患者为男性。最常见的合并症是高血压（55%）、糖尿病（31%）和慢性肺部疾病（15%）。托珠单抗组有 18 例死亡（27.3%），无托珠单抗组有 18 例死亡（27.3%）（比值比，1.0；95%置信区间，0.465-2.151；p=1.00）。在死亡患者中，高龄、心肌梗死史、痴呆、慢性肺部疾病、心力衰竭和恶性肿瘤更为常见。目前的分析不支持使用托珠单抗治疗 COVID-19 患者的细胞因子风暴。在获得更多证据之前，应将该治疗药物的使用限于临床试验背景。
