概括
在患有缺氧和全身炎症的住院COVID-19患者中,tocilizumab显著提高了生存率. 这种治疗改善了临床结果,包括出院,并降低了死亡风险.
科学领域:
- 危急护理医学
- 传染性疾病
- 药理学
背景情况:
- COVID-19 的特征是缺氧和严重病例的全身炎症.
- 托西利祖马布是一种互白素-6受体抑制剂,已被研究其在严重的COVID-19中具有免疫调节作用.
- 评估托西利祖马布在患有缺氧和炎症的住院COVID-19患者的疗效至关重要.
研究的目的:
- 评估托西利祖马布对住院COVID-19患者的死亡率和临床结果的影响.
- 确定托西利祖马布在该患者群体中是否提供超越标准治疗的好处.
主要方法:
- 一个随机的,受控的,开放的平台试验 (RECOVERY) 涉及英国住院的COVID-19患者.
- 符合条件的患者有缺氧 (氧和率<92%或需要氧气) 和全身炎症 (C反应蛋白≥75 mg/ l).
- 参与者按1:1随机分配到通常的护理或通常的护理加托西利祖马布 (400- 800毫克静脉注射,可能有第二剂量).
主要成果:
- 在4116名患者中,托西利祖马布降低了28天的死亡率 (31%对35%;率比为0.85, p=0. 0028).
- 接受tocilizumab的患者出院率较高 (57%对50%),需要机械呼吸或死亡的可能性较低 (35%对42%).
- 包括系统性皮质类固醇患者在内的各个子组的益处一致.
结论:
- 在患有缺氧和全身炎症的住院COVID-19患者中,托西利祖马布显著改善了生存和临床结果.
- 托西利祖马布的益处与呼吸辅助水平无关.
- 托西利祖马布的积极作用是系统性皮质类固醇的附加效应.
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