RT Journal Article
SR Electronic
T1 Impact of Timing of Tocilizumab Use in Hospitalized Patients With SARS-CoV-2 Infection
JF Respiratory Care
FD American Association for Respiratory Care
SP 1805
OP 1814
DO 10.4187/respcare.08779
VO 66
IS 12
A1 Anup K Singh
A1 Margarita Oks
A1 Gregg Husk
A1 Samuel P Dechario
A1 Bushra Mina
A1 Kanwaljit Singh
A1 Linda Kirschenbaum
A1 Charles M Carpati
A1 Omar Mahmoud
A1 Nader Ishak Gabra
A1 Oki Ishikawa
A1 Erica Altschultz
A1 Varun Shah
A1 Akhilesh Mahajan
A1 Arun Gautam
A1 Brian Birnbaum
A1 Anthony C Antonacci
A1 Suhail Raoof
YR 2021
UL http://rc.rcjournal.com/content/66/12/1805.abstract
AB BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) continues to be a global challenge due to the lack of definitive treatment strategies. We sought to determine the efficacy of early administration of anti-interleukin 6 therapy in reducing hospital mortality and progression to mechanical ventilation.METHODS: This was a retrospective chart review of 11,512 patients infected with SARS-CoV-2 who were admitted to a New York health system from March to May 2020. Tocilizumab was administered to subjects at the nasal cannula level of oxygen support to maintain an oxygen saturation of >88%. The Charlson comorbidity index was used as an objective assessment of the burden of comorbidities to predict 10-year mortality. The primary outcome of interest was hospital mortality. Secondary outcomes were progression to mechanical ventilation; the prevalence of venous thromboembolism and renal failure; and the change in C-reactive protein, D-dimer, and ferritin levels after tocilizumab administration. Propensity score matching by using a 1:2 protocol was used to match the tocilizumab and non-tocilizumab groups to minimize selection bias. The groups were matched on baseline demographic characteristics, including age, sex, and body mass index; Charlson comorbidity index score; laboratory markers, including ferritin, D-dimer, lactate dehydrogenase, and C-reactive protein values; and the maximum oxygen requirement at the time of tocilizumab administration. Mortality outcomes were evaluated based on the level of oxygen requirement and the day of hospitalization at the time of tocilizumab administration.RESULTS: The overall hospital mortality was significantly reduced in the tocilizumab group when tocilizumab was administered at the nasal cannula level (10.4% vs 22.0%; P = .002). In subjects who received tocilizumab at the nasal cannula level, the progression to mechanical ventilation was reduced versus subjects who were initially on higher levels of oxygen support (6.3% vs 18.7%; P < .001). There was no improvement in mortality when tocilizumab was given at the time of requiring non-rebreather, high-flow nasal cannula, noninvasive ventilator, or invasive ventilator.CONCLUSIONS: Early use of anti-interleukin 6 therapy may be associated with improved hospital mortality and reduction in progression to more severe coronavirus disease 2019.