Binder Michael S, Timmerman Clinton, Marof Biwar, Wu Yingxing, Bankole Adegbenga, Heletz Ido
Department of Cardiology, Virginia Tech Carilion Roanoke Memorial Hospital, Roanoke, Virginia.
Department of Internal Medicine, Virginia Tech Carilion Roanoke Memorial Hospital, Roanoke, Virginia.
J Int Med Res. 2025 Apr;53(4):3000605251324590. doi: 10.1177/03000605251324590. Epub 2025 Apr 2.
ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic illustrated the relationship between cardiac arrhythmias and pro-inflammatory states. Pro-inflammatory cytokines, including interleukin-6 (IL-6), have significant effects on cardiac conduction. Atrial or ventricular arrhythmias occurring while infected results in a doubling of mortality. Tocilizumab, a monoclonal antibody that blocks the IL-6 receptor, is associated with improved mortality and is believed to be related to immune modulation of the COVID-19-related hyperinflammatory state.MethodsA single-center retrospective review of all patients with severe COVID-19, defined as admission to an intensive care unit or requirement of respiratory or circulatory support, from March 2020 through March 2022, was conducted. Patients who received or did not receive tocilizumab were grouped into the treatment and control groups, respectively.ResultsFour hundred seventy-three patients were reviewed and 400 met the criteria for inclusion in our study. There were 305 patients (age, 63 ± 13 years, 58% male) in the control group and 95 (age, 57 ± 15 years, 51% male) in the treatment group. In-hospital mortality was greatly reduced with tocilizumab compared with controls (44.2% vs 85.9%, p < 0.001) and new-onset atrial fibrillation (AF) showed a statistically significant reduction (17.8% vs 29.5%, p = 0.019). New-onset wall motion abnormalities, potentially related to myocarditis or acute coronary syndrome, also trended toward significance with tocilizumab (7.7% vs 15.7%, p = 0.10). Deep vein thrombosis, pulmonary embolism, stroke, and sustained ventricular arrhythmias did not meet statistical significance.ConclusionAs expected, tocilizumab did show significant improvement in mortality. Tocilizumab also showed a significant reduction of new-onset AF. Other cardiac structural endpoints did not reach statistical significance.A preliminary version of this research was presented during a regional conference at the Mid-Atlantic Capital Cardiology Symposium (MACCS) on 19 November 2023.
目的
2019年冠状病毒病（COVID-19）大流行阐明了心律失常与促炎状态之间的关系。包括白细胞介素-6（IL-6）在内的促炎细胞因子对心脏传导有显著影响。感染期间发生的房性或室性心律失常会使死亡率加倍。托珠单抗是一种阻断IL-6受体的单克隆抗体，与死亡率改善相关，并且被认为与COVID-19相关的高炎症状态的免疫调节有关。
方法
对2020年3月至2022年3月期间所有确诊为重症COVID-19的患者进行单中心回顾性研究，重症COVID-19定义为入住重症监护病房或需要呼吸或循环支持。接受或未接受托珠单抗治疗的患者分别被归入治疗组和对照组。
结果
共审查了473例患者，其中400例符合纳入本研究的标准。对照组有305例患者（年龄63±13岁，男性占58%），治疗组有95例患者（年龄57±15岁，男性占51%）。与对照组相比，托珠单抗显著降低了住院死亡率（44.2%对85.9%，p<0.001），新发心房颤动（AF）也有统计学显著降低（17.8%对29.5%，p=0.019）。与心肌炎或急性冠状动脉综合征可能相关的新发室壁运动异常，使用托珠单抗治疗也有显著趋势（7.7%对15.7%，p=0.10）。深静脉血栓形成、肺栓塞、中风和持续性室性心律失常未达到统计学显著性。
结论
正如预期的那样，托珠单抗确实显著改善了死亡率。托珠单抗还显著降低了新发AF。其他心脏结构终点未达到统计学显著性。
本研究的初步版本于2023年11月19日在大西洋中部心脏科研讨会（MACCS）的区域会议上发表。
