Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct:99:28-33.
doi: 10.1016/j.ijid.2020.07.023. Epub 2020 Jul 25.

Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge

Pranay Sinha  1 , Anahita Mostaghim  2 , Catherine G Bielick  2 , Angela McLaughlin  1 , Davidson H Hamer  3 , Lee M Wetzler  1 , Nahid Bhadelia  4 , Maura A Fagan  1 , Benjamin P Linas  1 , Sabrina A Assoumou  1 , Michael H Ieong  5 , Nina H Lin  1 , Ellen R Cooper  6 , Karrine D Brade  7 , Laura F White  8 , Tamar F Barlam  1 , Manish Sagar  9 ; Boston Medical Center Covid-19 Treatment Panel
Affiliations

Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge

Pranay Sinha et al. Int J Infect Dis. 2020 Oct.

Abstract

Objective: The aim of this observational study was to determine the optimal timing of interleukin-6 receptor inhibitor (IL6ri) administration for coronavirus disease 2019 (COVID-19).

Methods: Patients with COVID-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into two groups: those requiring ≤45% fraction of inspired oxygen (FiO2) (termed stage IIB) and those requiring >45% FiO2 (termed stage III) at the time of IL6ri administration. The main outcomes were all-cause mortality, discharge alive from hospital, and extubation.

Results: A total of 255 COVID-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than those treated in stage III (adjusted hazard ratio (aHR) 0.24, 95% confidence interval (CI) 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR 1.43, 95% CI 1.06-1.93) and were less likely to be intubated (aHR 0.43, 95% CI 0.24-0.79).

Conclusions: IL6ri administration prior to >45% FiO2 requirement was associated with improved COVID-19 outcomes. This can guide clinical management pending results from randomized controlled trials.

Keywords: COVID-19; Cytokine release syndrome; Interleukin-6 inhibitors; Sarilumab; Tocilizumab.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival curves for patients treated with interleukin-6 inhibitors (IL6ri) in stage IIB and in stage III. Shown here are (A) differences in time to mortality after IL6ri dose, (B) differences in time to discharge after IL6ri, and (C) differences in time to intubation after IL6ri administration. The number of patients at risk for each outcome at different time-points are displayed below the survival curves.
Figure 2
Figure 2
(A) Patients alive after 10 000 Monte Carlo simulations at Boston Medical Center (BMC) and in the two arms of the remdesivir and dexamethasone trials respectively. (B) Frequency of being selected as optimal strategy.
See this image and copyright information in PMC

References

    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. - PMC - PubMed
    1. CDC COVID-19 Response Team Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343–346. - PMC - PubMed
    1. Geleris J., Sun Y., Platt J., Zucker J., Baldwin M., Hripcsak G. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med. 2020;382:2411–2418. - PMC - PubMed
    1. Goyal P., Choi J.J., Pinheiro L.C., Schenck E.J., Chen R., Jabri A. Clinical characteristics of Covid-19 in New York City. N Engl J Med. 2020;382:2372–2374. - PMC - PubMed
    1. Audit ICN, Centre R . Intensive Care National Audit & Research Centre; London: 2020. ICNARC report on COVID-19 in critical care.https://www.icnarc.org/DataServices/Attachments/Download/c5a62b13-6486-e...