Pharmacy Department, Vall Hebron Barcelona Campus Hospital, Barcelona, Spain.
Pharmacy Department, Vall Hebron Barcelona Campus Hospital, Barcelona, Spain.
Med Clin (Barc). 2022 Apr 8;158(7):301-307. doi: 10.1016/j.medcli.2021.03.005. Epub 2021 May 6.
Tocilizumab is an interleukin-6 receptor-blocking agent proposed for the treatment of severe COVID-19; however, limited data are available on their efficacy. The aim of this study was to assess the effect of tocilizumab on the outcomes of patients with COVID-19 pneumonia by using propensity-score-matching (PSM) analysis.
A retrospective observational analysis of hospitalized COVID-19 adult patients admitted to the Vall d'Hebron Hospital was performed between March and April 2020. We used the logistic regression to analyze the effect of tocilizumab on mortality, as main outcome, and PSM analysis to further validate their effect. Secondary outcomes were length-of-stay (LOS) and intensive-care-unit (ICU) stay. Same outcomes were also assessed for early tocilizumab administration, within 72h after admission. Patients were selected by matching their individual propensity for receiving therapy with tocilizumab, conditional on their demographic and clinical variables.
A total of 544 COVID-19 patients were included, 197 (36.2%) were treated with tocilizumab of whom 147 were treated within the first 72h after admission; and 347 were included in the control group. After PSM analyses, the results showed no association between tocilizumab use and overall mortality (OR=1.03, 95%CI: 0.63-1.68). However, shorter ICU-stay in the tocilizumab group was found compared to the control group (Coefficient -4.27 95%CI: -6.63 to -1.92). Similar results were found in the early tocilizumab cohort.
The administration of tocilizumab in patients with moderate to severe COVID-19 did not reduce the risk of mortality in our cohort of patients, regardless of the time of administration.
托珠单抗是一种白介素-6 受体阻断剂，被提议用于治疗严重的 COVID-19；然而，关于其疗效的数据有限。本研究的目的是通过倾向评分匹配（PSM）分析评估托珠单抗对 COVID-19 肺炎患者结局的影响。
对 2020 年 3 月至 4 月期间入住瓦尔德希伯伦医院的 COVID-19 成年住院患者进行了回顾性观察性分析。我们使用逻辑回归分析托珠单抗对死亡率的影响，作为主要结局，并使用 PSM 分析进一步验证其效果。次要结局是住院时间（LOS）和重症监护病房（ICU）入住时间。还评估了早期托珠单抗治疗（入院后 72 小时内）的相同结局。通过匹配患者接受托珠单抗治疗的个体倾向，根据他们的人口统计学和临床变量，选择患者。
共纳入 544 例 COVID-19 患者，197 例（36.2%）接受了托珠单抗治疗，其中 147 例在入院后 72 小时内接受了治疗；347 例纳入对照组。经过 PSM 分析后，结果显示托珠单抗的使用与总体死亡率之间没有关联（OR=1.03，95%CI：0.63-1.68）。然而，与对照组相比，托珠单抗组的 ICU 入住时间更短（系数-4.27，95%CI：-6.63 至-1.92）。在早期托珠单抗队列中也发现了类似的结果。
在我们的患者队列中，无论给药时间如何，在中重度 COVID-19 患者中使用托珠单抗并不能降低死亡率风险。
