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Case Reports
. 2022 Jun 24;158(12):608-612.
doi: 10.1016/j.medcli.2021.06.014. Epub 2021 Jun 18.

Tocilizumab therapy in SARS-CoV-2 pneumonia: A matched retrospective cohort analysis

[Article in English, Spanish]
Mario Fernández-Ruiz  1 , Francisco López-Medrano  2 , Octavio Carretero  3 , Patricia Parra  3 , Tamara Ruiz-Merlo  3 , José María Aguado  2 ; H12O Immunomodulation Therapy for COVID-19 Group
Affiliations
Case Reports

Tocilizumab therapy in SARS-CoV-2 pneumonia: A matched retrospective cohort analysis

[Article in English, Spanish]
Mario Fernández-Ruiz et al. Med Clin (Barc). .

Abstract
in English, Spanish

Background: The effect of immunomodulatory therapy with tocilizumab for coronavirus disease 2019 (COVID-19) in real-life clinical practice remains controversial.

Methods: Single-center retrospective matched cohort analysis including 47 consecutive patients treated with intravenous tocilizumab for severe COVID-19 pneumonia ("TCZ group"), matched by age, comorbidities, time from symptoms onset and baseline SpO2/FiO2 ratio with 47 patients receiving standard of care alone ("SoC group").

Results: There were no significant differences between the TCZ and SoC groups in the rate of clinical improvement (hospital discharge and/or a decrease of ≥2 points on a six-point ordinal scale) by day 7 (51.1% [24/47] versus 48.9% [23/47]; P-value=1.000). No differences were observed at day 14 in terms of clinical improvement (72.3% versus 76.6%; P-value=0.791), all-cause mortality (10.6% versus 12.8%; P-value=1.000), and the composite of invasive mechanical ventilation and/or death (25.5% versus 23.4%; P-value=1.000) either. Patients in the TCZ group had a more rapid normalization of C-reactive protein levels.

Conclusions: No apparent benefit was observed in patients with severe COVID-19 treated with tocilizumab as compared to a matched retrospective cohort.

Antecedentes: El efecto del tratamiento inmunomodulador con tocilizumab en la COVID-19 sigue siendo controvertido.

Métodos: Estudio unicéntrico de cohortes retrospectivas pareadas que incluyó a 47 pacientes con COVID-19 grave tratados con tocilizumab intravenoso («grupo TCZ»), emparejados por edad, comorbilidades mayores, evolución de síntomas y cociente SpO2/FiO2 basal con 47 pacientes que recibieron tratamiento estándar únicamente («grupo SoC»).

Resultados: No observamos diferencias significativas entre los grupos de TCZ y SoC en la tasa de mejoría clínica (alta hospitalaria y/o descenso de ≥ 2 puntos en una escala ordinal de 6 puntos) al día 7 (51,1% [24/47] vs. 48,9% [23/47]; P = 1,000). Tampoco hubo diferencias al día 14 en las tasas de mejoría clínica (72,3% vs. 76,6%; P = 0,791), mortalidad (10,6% vs. 12,8%; P = 1,000) o en el compuesto de ventilación mecánica invasiva y/o muerte (25,5% vs. 23,4%; P = 1,000). Los pacientes en el grupo de TCZ presentaron una normalización más rápida de la proteína C reactiva.

Conclusiones: Respecto a una cohorte retrospectiva pareada, no detectamos un beneficio asociado al tratamiento con tocilizumab en pacientes con neumonía por COVID-19.

Keywords: COVID-19; Estudio de cohortes pareadas; Evolución; Immunomodulatory therapy; Matched cohort study; Outcome; Tocilizumab; Tratamiento inmunomodulador.

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Figures

Fig. 1
Fig. 1
Patient status according to the six-point ordinal scale at different times in the TCZ and SoC groups. The median scores were similar in both groups, either by day 7 (1 [IQR: 1–4] versus 2 [IQR: 1–3]; P-value = 0.870) or day 14 (1 [IQR: 1–3] versus 1 [IQR: 1–2], respectively; P-value = 0.871). ECMO: extracorporeal membrane oxygenation; IMV: invasive mechanical ventilation; SoC: standard of care; TCZ: tocilizumab.
Fig. 2
Fig. 2
Kaplan–Meier incidence curves for clinical improvement from day 0 to day 14 revealing no significant differences between the TCZ and SoC groups (log-rank P-value = 0.578). SoC: standard of care; TCZ: tocilizumab.
See this image and copyright information in PMC

References

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