Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19

International Journal of Infectious Diseases

Francisco López-Medrano¹  Carlos Gómez²  Mar Ripoll³  María Asunción Pérez-Jacoiste Asín⁴  Antonio Lalueza⁴  Fernando Aguilar⁴  Mario Fernández-Ruiz⁴  Tamara Ruiz-Merlo⁵  Eduardo Gutiérrez⁶  Manuel Lizasoáin⁷  Mercedes Catalán⁸  Estela Paz-Artal⁸  Carlos Lumbreras⁸  Joaquín Martínez-López⁸  José Manuel Caro-Teller⁸  Cristina de la Calle⁸  Ángel Sevillano⁹  Patricia Parra^1,10  Rocío García-García^1,10  Hernando Trujillo^1,11  José Luis Pablos^1,11  Rocío Laguna-Goya^1,12  Julia Origüen^1,13  Borja de Miguel^1,14  Rafael San-Juan^1,14  Guillermo Maestro de la Calle^1,14  Octavio Carretero^1,14  Héctor Bueno^1,14  José María Aguado^1,14 

[1] Corresponding author. Rafael San-Juan, MD, PhD. Unit of Infectious Diseases. Hospital Universitario ''12 de Octubre''. Centro de Actividades Ambulatorias, 2ª planta, bloque D. Avda. de Córdoba, s/n. Postal code 28041. Madrid, Spain. Phone: [phone]. Fax: [phone].;Department of Cardiology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Hematology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Centro Nacional de Investigaciones Oncológicas (CNIO), Universidad Complutense, Madrid, Spain;Department of Medicine, School of Medicine, Universidad Complutense, Madrid;Department of Emergency Medicine, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Immunology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Intensive Care Medicine, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Internal Medicine, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Medical Oncology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Medicine, School of Medicine, Universidad Complutense, Madrid;Department of Nephrology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Pharmacy, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Department of Pneumology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;Unit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain;

关键词: COVID-19;    tocilizumab;    clinical response;    predictors;    early initiation;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients. Methods: We retrospectively analyzed a cohort of patients with severe COVID-19 who received off-label TCZ after recommendation by a local committee and were admitted to the University Hospital “12 de Octubre” until May 2020. The primary end point was a significant clinical improvement (SCI) on day 14 after administration of TCZ. Factors independently related to SCI were analyzed by multivariate logistic regression models. Results: Of 428 (63.3%) patients treated with TCZ, 271 (63.3%) experienced SCI. After adjustment for factors related to unfavorable outcomes, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1–3.55; P = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI: 1.3–8.1; P = 0.01) were independently related to SCI. The rate of SCI significantly decreased according to the time of TCZ administration: 70.2% in the first 48 hours from admission, 58.5% on days 3-7, and 45.1% after day 7 (P = 0.03 and P = 0.001, respectively). Conclusion: TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission.

【 授权许可】

Unknown