Faculty of Medicine, Bursa Uludağ University, Turkey.
Adv Clin Exp Med. 2022 Nov;31(11):1197-1206. doi: 10.17219/acem/151912.
The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.
To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.
Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.
A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).
This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.
白细胞介素 6（IL-6）在 2019 年冠状病毒病（COVID-19）肺炎中的潜在作用为研究 IL-6 信号抑制剂提供了依据。
评估并报告托珠单抗（TCZ）治疗 COVID-19 患者的治疗反应，并将死亡率结果与标准治疗进行比较。
这项单中心回顾性队列研究纳入了 2020 年 3 月至 2021 年 4 月期间因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染住院、经逆转录聚合酶链反应（RT-PCR）确诊的 COVID-19 患者。为了减少因接受 TCZ 治疗而导致的不平衡所产生的混杂影响，进行了倾向评分匹配。
共有 364 名患者纳入本研究。236 名患者接受了标准治疗，128 名患者在标准治疗的基础上加用 TCZ（26 名（20.3%）患者静脉注射 400mg 单次剂量，102 名（79.7%）患者静脉注射总剂量 800mg）。在倾向评分匹配人群中，TCZ 治疗组接受无创机械通气（p=0.041）和机械通气支持（p=0.015）的患者较少，死亡患者较少（p=0.008）。多变量调整的 Cox 回归模型显示，TCZ 治疗组患者的生存率明显高于对照组（风险比（HR）：0.157，95%置信区间（95%CI）：0.026-0.951；p=0.044）。TCZ 组的死亡率 HR 为 0.098（95%CI：0.030-0.318；log-rank 检验 p=0.0001）。
本研究表明，COVID-19 患者接受 TCZ 治疗与更好的生存率、减少机械通气需求和降低医院相关死亡率相关。
