Flisiak Robert, Jaroszewicz Jerzy, Rogalska Magdalena, Łapiński Tadeusz, Berkan-Kawińska Aleksandra, Bolewska Beata, Tudrujek-Zdunek Magdalena, Kozielewicz Dorota, Rorat Marta, Leszczyński Piotr, Kłos Krzysztof, Kowalska Justyna, Pabjan Paweł, Piekarska Anna, Mozer-Lisewska Iwona, Tomasiewicz Krzysztof, Pawłowska Małgorzata, Simon Krzysztof, Polanska Joanna, Zarębska-Michaluk Dorota
Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Białystok, Poland.
Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland.
J Clin Med. 2021 Apr 9;10(8):1583. doi: 10.3390/jcm10081583.
Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08-0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.
尽管存在直接的病毒作用，但2019冠状病毒病（COVID-19）的发病机制包括细胞因子过度产生，其中包括白细胞介素6（IL-6）。因此，抗IL-6受体单克隆抗体托珠单抗（TOC）被视为一种可能的治疗选择。患者选自SARSTer数据库，该数据库包含2332例COVID-19患者。本研究纳入了825例中重度病程的成年患者。对170例接受TOC治疗的患者和655例接受替代药物治疗的患者进行了分析。治疗效果的终点指标为死亡率、机械通气需求和临床改善情况。与未接受TOC治疗的患者相比，接受TOC治疗的患者在性别、年龄、体重指数和并存疾病患病率方面具有平衡性。在基线IL-6>100 pg/mL的患者中，TOC对死亡有显著影响（风险比[HR]：0.21，95%置信区间[CI]：0.08-0.57）。在基线IL-6>100 pg/mL且伴有SpO2≤90%（HR：0.07）或需要吸氧（HR：0.18）的患者中，TOC取得了最佳疗效。在COVID-19患者中，给予托珠单抗可降低死亡率，并加快基线IL-6>100 pg/mL患者的临床改善，特别是那些因SpO2≤90%而需要吸氧的患者。
