Infectious Disease Unit, University of Modena and Reggio Emilia, Modena, Italy.
Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Braz J Infect Dis. 2022 Jan-Feb;26(1):101702. doi: 10.1016/j.bjid.2021.101702. Epub 2021 Dec 21.
To estimate the effect of tocilizumab or glucocorticoids in preventing death and intubation in patients hospitalized with SARS-CoV-2 pneumonia.
This was a retrospective cohort study enrolling all consecutive patients hospitalized at Reggio Emilia AUSL between February the 11 and April 14 2020 for severe COVID-19 and treated with tocilizumab or glucocorticoids (at least 80 mg/day of methylprednisolone or equivalent for at least 3 days). The primary outcome was death within 30 days from the start of the considered therapies. The secondary outcome was a composite outcome of death and/or intubation. All patients have been followed-up until May 19 2020, with a follow-up of at least 30 days for every patient. To reduce confounding due to potential non-comparability of the two groups, those receiving tocilizumab and those receiving glucocorticoids, a propensity score was calculated as the inverse probability weighting of receiving treatment conditional on the baseline covariates.
Therapy with tocilizumab alone was associated with a reduction of deaths (OR 0.49, 95% CI 0.21-1.17) and of the composite outcome death/intubation (OR 0.35, 95% CI 0.13-0.90) compared to glucocorticoids alone. Nevertheless, this result should be cautiously interpreted due to a potential prescription bias.
评估托珠单抗或糖皮质激素对预防因 SARS-CoV-2 肺炎住院患者死亡和插管的作用。
这是一项回顾性队列研究，纳入了 2020 年 2 月 11 日至 4 月 14 日在雷焦艾米利亚 AUSL 连续住院的所有因严重 COVID-19 而接受托珠单抗或糖皮质激素治疗（至少 80mg/天的甲泼尼龙或等效药物至少 3 天）的患者。主要结局是在开始考虑的治疗后 30 天内死亡。次要结局是死亡和/或插管的复合结局。所有患者均随访至 2020 年 5 月 19 日，每位患者的随访时间至少为 30 天。为了减少由于两组（接受托珠单抗的患者和接受糖皮质激素的患者）之间潜在的不可比性而导致的混杂因素，根据基线协变量计算了接受治疗的倾向评分。
与单独使用糖皮质激素相比，单独使用托珠单抗可降低死亡率（OR 0.49，95%CI 0.21-1.17）和死亡/插管的复合结局（OR 0.35，95%CI 0.13-0.90）。然而，由于可能存在处方偏倚，因此应谨慎解释这一结果。
