Efficacy of tocilizumab in patients with COVID-19 ARDS undergoing noninvasive ventilation

Critical Care

Carlo Salvarani¹  Pamela Mancuso²  Marco Massari³  Nicola Facciolongo⁴  Matteo Fontana⁴  Chiara Barbieri⁴  Francesco Falco⁴  Chiara Scelfo⁴  Giulia Ghidoni⁴  Chiara Catellani⁴  Gloria Montanari⁴  Luca Ghidorsi⁴  Claudia Castagnetti⁴  Eleonora Casalini⁴  Francesco Livrieri⁴  Patrizia Ruggiero⁴  Francesco Menzella⁴  Roberto Piro⁴  Giorgia Gibellini⁴ 

[1] Division of Rheumatology, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy;University of Modena and Reggio Emilia, Modena, Italy;Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy;Infectious Disease Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy;Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy;

关键词: SARS-CoV-2;    COVID-19;    Acute respiratory distress syndrome;    Tocilizumab;    Noninvasive ventilation;   

DOI  :  10.1186/s13054-020-03306-6

来源: Springer

【 摘 要 】

BackgroundThe severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is extremely variable, ranging from asymptomatic patients to those who develop severe acute respiratory distress syndrome (ARDS). As for now, there are still no really effective therapies for coronavirus disease 2019 (COVID-19). Some evidences suggest that tocilizumab (TCZ) may avoid the progression of severe COVID-19. The aim of this retrospective case-control study was to analyze the efficacy and safety of TCZ in patients with COVID-19 ARDS undergoing noninvasive mechanical ventilation (NIV).MethodsSeventy-nine consecutive patients with severe COVID-19 pneumonia and worsening acute respiratory failure (ARF) were admitted to the Pulmonology Unit of Azienda USL of Reggio Emilia-IRCCS. All patients were inflamed (elevated CRP and IL-6 levels) and received NIV at admission according to the presence of a pO2/FiO2 ratio ≤ 200 mmHg. The possibility of being treated with TCZ depended on the drug availability. The primary outcome was the in-hospital mortality rate. A secondary composite outcome of worsening was represented by the patients who died in the pulmonology unit or were intubated.ResultsOut of 79 patients, 41 were treated with TCZ. Twenty-eight patients received intravenous (IV) TCZ and 13 patients received subcutaneous (SC) TCZ. In-hospital overall mortality rate was 38% (30/79 patients). The probabilities of dying and being intubated during the follow-up using Kaplan-Meier method were significantly lower in total patients treated with TCZ compared to those of patients not treated with TCZ (log-rank p value = 0.006 and 0.036, respectively). However, using Cox multivariate analyses adjusted for age and Charlson comorbidity index only the association with the reduced risk of being intubated or dying maintained the significance (HR 0.44, 95%CI 0.22–0.89, p = 0.022). Two patients treated with TCZ developed cavitating lung lesions during the follow-up.ConclusionsThis study shows that TCZ treatment may be effective in COVID-19 patients with severe respiratory impairment receiving NIV. More data on safety are required. Randomized controlled trials are needed to confirm these results.

【 授权许可】

CC BY