Tunis Med. 2022;100(4):309-312.
Tocilizumab (TCZ), a humanized monoclonal antibody directed against interleukin-6 (IL-6) receptors, has been tried in various studies as a Covid-19 therapy with controversial results.
To evaluate the effectiveness of adding TCZ to standard care (SC) in critical Covid-19 patients.
it was designed retrospectively as a comparative study on two paired series of critical patients affected with Covid-19: the 1st group received TCZ plus SC versus a 2nd group which received only SC. The matching criteria were age, sex and severity score and the matching was based on the propensity score matching (PSM) by the nearest neighbor. Outcomes were: survival, mechanical ventilation (MV) and nosocomial infections.
Ninety patients were included by pairing estimated successful (PSM > 0.5 in more than 50% in each group for all matching criteria). 55.5% of SC group progressed to stage 3-acute respiratory distress syndrome (ARDS) versus 31% of TCZ+SC patients (p=0.03). No effect of TCZ was found on mortality (49% in each group, p=1) nor on MV use (p=0.67). ICU stay was more prolonged in TCZ+SC group (16 versus 8 days, p<10-3). The administration of TCZ induced a significant decrease in CRP but not changed the IL-6 dosage. Nosocomial infections occurred in 18 (40%) of TCZ+SC group comparatively to 15 (33,5%) of SC group, p=0.66.
Tocilizumab reduced the risk of progression to severe ARDS probably due to its immune-modulating properties. But no beneficial effect was found on survival or on the use of ventilation.
托珠单抗（TCZ）是一种针对白细胞介素-6（IL-6）受体的人源化单克隆抗体，已在各种研究中尝试作为 COVID-19 治疗方法，但结果存在争议。
评估将 TCZ 添加到标准治疗（SC）中对重症 COVID-19 患者的疗效。
这是一项回顾性比较研究，比较了两组配对的 COVID-19 重症患者：第 1 组接受 TCZ 加 SC 治疗，第 2 组仅接受 SC 治疗。匹配标准为年龄、性别和严重程度评分，并通过最近邻的倾向评分匹配（PSM）进行匹配。结果为：存活率、机械通气（MV）和医院感染。
通过配对成功估计（每组中所有匹配标准的 PSM>0.5 的比例超过 50%）纳入了 90 名患者。SC 组进展为 3 期急性呼吸窘迫综合征（ARDS）的比例为 55.5%，而 TCZ+SC 组为 31%（p=0.03）。TCZ 对死亡率（每组均为 49%，p=1）或 MV 使用（p=0.67）没有影响。TCZ+SC 组 ICU 停留时间延长（16 天对 8 天，p<10-3）。TCZ 给药显著降低 CRP，但不改变 IL-6 剂量。TCZ+SC 组发生医院感染 18 例（40%），SC 组发生 15 例（33.5%），p=0.66。
托珠单抗降低了进展为严重 ARDS 的风险，可能是由于其免疫调节特性。但对存活率或通气使用没有发现有益影响。
