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A Propensity-Matched Cohort Study of Tocilizumab in Patients With Coronavirus Disease 2019

Tyler C Lewis1,2, Samrachana Adhikari3, Vasishta Tatapudi2

  • 1Department of Pharmacy, NYU Langone Health, New York, NY.

Critical Care Explorations
|November 23, 2020
PubMed

Insights

Tocilizumab treatment significantly improved survival for patients with coronavirus disease 2019. However, this benefit was linked to longer ICU stays and higher infection rates, warranting further investigation.

Area of Science:

  • Immunology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is a global health crisis.
  • Interleukin-6 (IL-6) receptor blockade is a potential therapeutic strategy.

Purpose of the Study:

  • To evaluate the impact of tocilizumab on survival in hospitalized COVID-19 patients.
  • To assess secondary outcomes including hospital discharge, ICU length of stay, and infection rates.

Main Methods:

  • Observational cohort study with propensity-matched analysis (1:1) of 3,580 hospitalized COVID-19 patients.
  • Competing risk survival analysis for mortality; regression models for secondary outcomes.
  • Tocilizumab (400-mg IV) plus standard of care versus standard of care alone.

Main Results:

  • Tocilizumab therapy was associated with significantly improved survival (HR=0.24, p<0.001).
  • No significant difference in time to hospital discharge (HR=0.96, p=0.67).
  • Increased ICU length of stay (RR=3.1, p<0.001) and infection rates (OR=4.18, p<0.001) observed.

Conclusions:

  • Tocilizumab therapy demonstrated a significant survival benefit in COVID-19 patients.
  • Survival advantage was accompanied by increased ICU stay and infection risk.
  • Further randomized controlled trials are necessary to confirm these findings.

Keywords:
coronavirus disease 2019hyperinflammationinterleukin 6respiratory failuresurvivaltocilizumab

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