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. 2022;100(4):309-312.

Beneficial of adding Tocilizumab to standard care in critical forms of Covid-19 pneumonia: Study on paired series

Ahlem Trifi, Cyrine Abdennebi, Asma Mehdi, Kais Ben Romdhane, Youssef Blel, Foued Daly, Boubaker Zakhama, Taher Mestiri, Sami Abdellatif, Salah Ben Lakhal

Beneficial of adding Tocilizumab to standard care in critical forms of Covid-19 pneumonia: Study on paired series

Ahlem Trifi et al. Tunis Med. 2022.

Abstract
in English, French

Introduction: 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.

Aim: To evaluate the effectiveness of adding TCZ to standard care (SC) in critical Covid-19 patients.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction : Le tocilizumab (TCZ), un anticorps monoclonal humanisé dirigé contre les récepteurs de l'interleukine-6 ​​(IL-6), a été essayé dans de nombreuses études en tant que thérapeutique anti Covid-19 avec des résultats controversés.

Objectif : Nous avons cherché à évaluer l'efficacité de l'ajout de TCZ aux soins standard (SS) chez les patients critiques atteints par la Covid-19.

Méthodes : étude rétrospective comparative sur deux séries appariées de patients critiques atteints de Covid-19 : le 1er groupe a reçu TCZ plus SS versus un 2ème groupe qui a reçu uniquement les SS. Les critères d'appariement étaient l'âge, le sexe et le score de sévérité et l'appariement était basé sur le score de propension d’appariement (SPA) par le plus proche voisin. Les critères de jugement étaient : la survie, la ventilation mécanique (VM) et les infections nosocomiales.

Résultats : Quatre-vingt-dix patients ont été inclus par appariement estimé réussi (SPA > 0,5 dans plus de 50 % de chaque groupe pour tous les critères d’appariement). 55,5 % des patients du groupe SS ont évolué vers le stade 3 du syndrome de détresse respiratoire aiguë (SDRA) versus 31 % des patients TCZ + SS (p=0,03). Aucun effet de l’adjonction du TCZ n'a été retrouvé sur la mortalité (49% dans chaque groupe, p=1) ni sur l'utilisation de la VM (p=0,67). Le séjour en USI était plus prolongé dans le groupe TCZ+SC (16 versus 8 jours, p<10-3). L'administration de TCZ a induit une diminution significative de la CRP mais n'a pas modifié le dosage d'IL-6. Des infections nosocomiales étaient survenues chez 18 (40 %) du groupe TCZ+SS comparativement à 15 (33,5 %) du groupe SS, p = 0,66.

Conclusion : Le tocilizumab a réduit le risque d’évolution vers un SDRA sévère probablement grâce à ses propriétés immuno-modulatrices. Mais aucun effet bénéfique n’a été retrouvé sur la survie ni sur le recours à la ventilation.

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Figures

None
Figure 1. Patients distribution according to the PSM by applyingthe 3 pairing criteria (age, sex, SAPS II).
PSM: propensity score matching SAPS: Simplified Acute Physiology Score, TCZ: Tocilizumab, SC: standard care,
See this image and copyright information in PMC

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