Int J Clin Pharmacol Ther. 2021 Nov;59(11):705-712. doi: 10.5414/CP203954.
Coronavirus disease 19 (COVID-19) can have a severe presentation characterized by a dysregulated immune response requiring admission to the intensive care unit (ICU). Immunomodulatory treatments like tocilizumab were found to improve inflammatory markers and lung injury over time. We aim to evaluate the effectiveness of tocilizumab treatment on critically ill patients with severe COVID-19.
We conducted a multi-center retrospective cohort study of 154 adult patients admitted to the ICU for severe COVID-19 pneumonia between March 15 and May 8, 2020. Data were obtained by electronic medical record (EMR) review. The primary outcome of interest was mortality.
Of 154 patients, 34 (21.4%) received tocilizumab. Compared to the non-treated group, the treated group was significantly younger, had fewer comorbidities, lower creatinine and procalcitonin levels, and higher alanine aminotransferase levels on admission. The treated group was more likely to receive supportive measures in the context of critical illness. The overall case fatality rate was 71.4%, and it was significantly lower in the treated than the non-treated (52.9 vs. 76.7%, p = 0.007). In multivariable survival analysis, tocilizumab treatment was associated with a 2.1 times lower hazard of mortality when compared to those who were not treated (hazard ratio: 0.47; 95% CI: 0.27, 0.83; p = 0.009). The prevalence of secondary infection was higher in the treated group compared to the non-treated without significant difference (p = 0.17).
Tocilizumab treatment for critically ill patients with COVID-19 resulted in a lower likelihood of mortality.
新冠肺炎（COVID-19）可表现为严重的免疫失调，需要入住重症监护病房（ICU）。研究发现，托珠单抗等免疫调节治疗可改善炎症标志物和肺损伤。我们旨在评估托珠单抗治疗对重症 COVID-19 患者的疗效。
我们对 2020 年 3 月 15 日至 5 月 8 日期间因重症 COVID-19 肺炎入住 ICU 的 154 例成年患者进行了一项多中心回顾性队列研究。通过电子病历（EMR）回顾获取数据。主要观察终点为死亡率。
在 154 例患者中，34 例（21.4%）接受了托珠单抗治疗。与未治疗组相比，治疗组患者年龄较小，合并症较少，入院时肌酐和降钙素原水平较低，丙氨酸氨基转移酶水平较高。治疗组在危重病时更有可能接受支持治疗。总病死率为 71.4%，治疗组明显低于未治疗组（52.9%比 76.7%，p=0.007）。多变量生存分析显示，与未治疗组相比，托珠单抗治疗组的死亡率降低了 2.1 倍（风险比：0.47；95%CI：0.27，0.83；p=0.009）。与未治疗组相比，治疗组继发性感染的发生率较高，但无显著差异（p=0.17）。
托珠单抗治疗 COVID-19 重症患者可降低死亡率。
