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Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- Source :
- The Lancet Rheumatology, American Journal of Therapeutics
- Publication Year :
- 2020
-
Abstract
- Background: No therapy is approved for COVID-19 pneumonia. The aim of this study was to assess the role of tocilizumab in reducing the risk of invasive mechanical ventilation and death in patients with severe COVID-19 pneumonia who received standard of care treatment. Methods: This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to tertiary care centres in Bologna and Reggio Emilia, Italy, between Feb 21 and March 24, 2020, and a tertiary care centre in Modena, Italy, between Feb 21 and April 30, 2020. All patients were treated with the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received tocilizumab. Tocilizumab was given either intravenously at 8 mg/kg bodyweight (up to a maximum of 800 mg) in two infusions, 12 h apart, or subcutaneously at 162 mg administered in two simultaneous doses, one in each thigh (ie, 324 mg in total), when the intravenous formulation was unavailable. The primary endpoint was a composite of invasive mechanical ventilation or death. Treatment groups were compared using Kaplan-Meier curves and Cox regression analysis after adjusting for sex, age, recruiting centre, duration of symptoms, and baseline Sequential Organ Failure Assessment (SOFA) score. Findings: Of 1351 patients admitted, 544 (40%) had severe COVID-19 pneumonia and were included in the study. 57 (16%) of 365 patients in the standard care group needed mechanical ventilation, compared with 33 (18%) of 179 patients treated with tocilizumab (p=0·41; 16 [18%] of 88 patients treated intravenously and 17 [19%] of 91 patients treated subcutaneously). 73 (20%) patients in the standard care group died, compared with 13 (7%; p
- Subjects :
- Mechanical ventilation
medicine.medical_specialty
medicine.drug_class
business.industry
medicine.medical_treatment
Immunology
Low molecular weight heparin
Retrospective cohort study
Azithromycin
medicine.disease
Article
chemistry.chemical_compound
Pneumonia
Tocilizumab
chemistry
Rheumatology
Internal medicine
severe covid-19, tocilizumab
medicine
Clinical endpoint
Immunology and Allergy
business
Letters to the Editor
Cohort study
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- The Lancet Rheumatology, American Journal of Therapeutics
- Accession number :
- edsair.doi.dedup.....225a261cd908f202b37219714d167c1f