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. 2022 May;23(3):225-230.
doi: 10.5152/TurkThoracJ.2022.21179.

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study

Selin Ercan  1 , Begüm Ergan  1 , Saliha Selin Özuygur  1 , Pervin Korkmaz  2 , Mehmet Sezai Taşbakan  2 , Özen K Basoglu  2 , Buğra Kerget  3 , Metin Akgün  3 , Osman Elbek  4 , Abdullah Sayıner  2 , Oğuz Kılınç  1
Affiliations

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study

Selin Ercan et al. Turk Thorac J. 2022 May.

Abstract

Objective: A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy.

Material and methods: The retrospective cohort study was conducted in 4 centers' both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality.

Results: In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058).

Conclusion: This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.

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Figures

Figure 1.
Figure 1.
Respiratory support in study population (numbers represent patient number; COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; IMV, invasive mechanical ventilation; NIV, non-invasive mechanical ventilation).
See this image and copyright information in PMC

References

    1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. 10.1016/j.jaut.2020.102433) - DOI - PMC - PubMed
    1. Lin SH, Zhao YS, Zhou DX, Zhou FC, Xu F. Coronavirus disease 2019 (COVID-19): cytokine storms, hyper-inflammatory phenotypes, and acute respiratory distress syndrome. Genes Dis. 2020;7(4):520 527. 10.1016/j.gendis.2020.06.009) - DOI - PMC - PubMed
    1. Ruscitti P, Berardicurti O, Di Benedetto P.et al. Severe COVID-19, another piece in the puzzle of the Hyperferritinemic syndrome. An immunomodulatory perspective to alleviate the storm. Front Immunol. 2020;11:1130. 10.3389/fimmu.2020.01130) - DOI - PMC - PubMed
    1. Masiá M, Fernández-González M, Padilla S.et al. Impact of Interleukin-6 Blockade with Tocilizumab on SARS-CoV-2 viral kinetics and antibody responses in patients with COVID-19: a prospective cohort study. EBioMedicine. 2020;60 : 102999. - PMC - PubMed
    1. Snow TAC, Saleem N, Ambler G, Nastouli E, Singer M, Arulkumaran N. Tocilizumab in COVID-19: a meta-analysis, trial sequential analysis, and meta-regression of randomized-controlled trials. Intensive Care Med. 2021;47(6):641 652. 10.1007/s00134-021-06416-z) - DOI - PMC - PubMed