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Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics

Background: Tocilizumab is a monoclonal antibody proposed to manage cytokine release syndrome (CRS) associated with severe COVID-19. Previously published reports have shown that tocilizumab may improve the clinical outcomes of critically ill patients admitted to the ICU. However, no precise data abo...

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Autores principales: Elhazmi, Alyaa, Rabie, Ahmed A., Al-Omari, Awad, Mufti, Hani N., Sallam, Hend, Alshahrani, Mohammed S., Mady, Ahmed, Alghamdi, Adnan, Altalaq, Ali, Azzam, Mohamed H., Sindi, Anees, Kharaba, Ayman, Al-Aseri, Zohair A., Almekhlafi, Ghaleb A., Tashkandi, Wail, Alajmi, Saud A., Faqihi, Fahad, Alharthy, Abdulrahman, Al-Tawfiq, Jaffar A., Melibari, Rami Ghazi, Arabi, Yaseen M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053430/
https://www.ncbi.nlm.nih.gov/pubmed/36983304
http://dx.doi.org/10.3390/jcm12062301
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author Elhazmi, Alyaa
Rabie, Ahmed A.
Al-Omari, Awad
Mufti, Hani N.
Sallam, Hend
Alshahrani, Mohammed S.
Mady, Ahmed
Alghamdi, Adnan
Altalaq, Ali
Azzam, Mohamed H.
Sindi, Anees
Kharaba, Ayman
Al-Aseri, Zohair A.
Almekhlafi, Ghaleb A.
Tashkandi, Wail
Alajmi, Saud A.
Faqihi, Fahad
Alharthy, Abdulrahman
Al-Tawfiq, Jaffar A.
Melibari, Rami Ghazi
Arabi, Yaseen M.
author_facet Elhazmi, Alyaa
Rabie, Ahmed A.
Al-Omari, Awad
Mufti, Hani N.
Sallam, Hend
Alshahrani, Mohammed S.
Mady, Ahmed
Alghamdi, Adnan
Altalaq, Ali
Azzam, Mohamed H.
Sindi, Anees
Kharaba, Ayman
Al-Aseri, Zohair A.
Almekhlafi, Ghaleb A.
Tashkandi, Wail
Alajmi, Saud A.
Faqihi, Fahad
Alharthy, Abdulrahman
Al-Tawfiq, Jaffar A.
Melibari, Rami Ghazi
Arabi, Yaseen M.
author_sort Elhazmi, Alyaa
collection PubMed
description Background: Tocilizumab is a monoclonal antibody proposed to manage cytokine release syndrome (CRS) associated with severe COVID-19. Previously published reports have shown that tocilizumab may improve the clinical outcomes of critically ill patients admitted to the ICU. However, no precise data about the role of other medical therapeutics concurrently used for COVID-19 on this outcome have been published. Objectives: We aimed to compare the overall outcome of critically ill COVID-19 patients admitted to the ICU who received tocilizumab with the outcome of matched patients who did not receive tocilizumab while controlling for other confounders, including medical therapeutics for critically ill patients admitted to ICUs. Methods: A prospective, observational, multicenter cohort study was conducted among critically ill COVID-19 patients admitted to the ICU of 14 hospitals in Saudi Arabia between 1 March 2020, and October 31, 2020. Propensity-score matching was utilized to compare patients who received tocilizumab to patients who did not. In addition, the log-rank test was used to compare the 28 day hospital survival of patients who received tocilizumab with those who did not. Then, a multivariate logistic regression analysis of the matched groups was performed to evaluate the impact of the remaining concurrent medical therapeutics that could not be excluded via matching 28 day hospital survival rates. The primary outcome measure was patients’ overall 28 day hospital survival, and the secondary outcomes were ICU length of stay and ICU survival to hospital discharge. Results: A total of 1470 unmatched patients were included, of whom 426 received tocilizumab. The total number of propensity-matched patients was 1278. Overall, 28 day hospital survival revealed a significant difference between the unmatched non-tocilizumab group (586; 56.1%) and the tocilizumab group (269; 63.1%) (p-value = 0.016), and this difference increased even more in the propensity-matched analysis between the non-tocilizumab group (466.7; 54.6%) and the tocilizumab group (269; 63.1%) (p-value = 0.005). The matching model successfully matched the two groups’ common medical therapeutics used to treat COVID-19. Two medical therapeutics remained significantly different, favoring the tocilizumab group. A multivariate logistic regression was performed for the 28 day hospital survival in the propensity-matched patients. It showed that neither steroids (OR: 1.07 (95% CI: 0.75–1.53)) (p = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61–1.9)) (p = 0.799) remained as a predictor for an increase in 28 day survival. Conclusion: The tocilizumab treatment in critically ill COVID-19 patients admitted to the ICU improved the overall 28 day hospital survival, which might not be influenced by the concurrent use of other COVID-19 medical therapeutics, although further research is needed to confirm this.
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spelling pubmed-100534302023-03-30 Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics Elhazmi, Alyaa Rabie, Ahmed A. Al-Omari, Awad Mufti, Hani N. Sallam, Hend Alshahrani, Mohammed S. Mady, Ahmed Alghamdi, Adnan Altalaq, Ali Azzam, Mohamed H. Sindi, Anees Kharaba, Ayman Al-Aseri, Zohair A. Almekhlafi, Ghaleb A. Tashkandi, Wail Alajmi, Saud A. Faqihi, Fahad Alharthy, Abdulrahman Al-Tawfiq, Jaffar A. Melibari, Rami Ghazi Arabi, Yaseen M. J Clin Med Article Background: Tocilizumab is a monoclonal antibody proposed to manage cytokine release syndrome (CRS) associated with severe COVID-19. Previously published reports have shown that tocilizumab may improve the clinical outcomes of critically ill patients admitted to the ICU. However, no precise data about the role of other medical therapeutics concurrently used for COVID-19 on this outcome have been published. Objectives: We aimed to compare the overall outcome of critically ill COVID-19 patients admitted to the ICU who received tocilizumab with the outcome of matched patients who did not receive tocilizumab while controlling for other confounders, including medical therapeutics for critically ill patients admitted to ICUs. Methods: A prospective, observational, multicenter cohort study was conducted among critically ill COVID-19 patients admitted to the ICU of 14 hospitals in Saudi Arabia between 1 March 2020, and October 31, 2020. Propensity-score matching was utilized to compare patients who received tocilizumab to patients who did not. In addition, the log-rank test was used to compare the 28 day hospital survival of patients who received tocilizumab with those who did not. Then, a multivariate logistic regression analysis of the matched groups was performed to evaluate the impact of the remaining concurrent medical therapeutics that could not be excluded via matching 28 day hospital survival rates. The primary outcome measure was patients’ overall 28 day hospital survival, and the secondary outcomes were ICU length of stay and ICU survival to hospital discharge. Results: A total of 1470 unmatched patients were included, of whom 426 received tocilizumab. The total number of propensity-matched patients was 1278. Overall, 28 day hospital survival revealed a significant difference between the unmatched non-tocilizumab group (586; 56.1%) and the tocilizumab group (269; 63.1%) (p-value = 0.016), and this difference increased even more in the propensity-matched analysis between the non-tocilizumab group (466.7; 54.6%) and the tocilizumab group (269; 63.1%) (p-value = 0.005). The matching model successfully matched the two groups’ common medical therapeutics used to treat COVID-19. Two medical therapeutics remained significantly different, favoring the tocilizumab group. A multivariate logistic regression was performed for the 28 day hospital survival in the propensity-matched patients. It showed that neither steroids (OR: 1.07 (95% CI: 0.75–1.53)) (p = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61–1.9)) (p = 0.799) remained as a predictor for an increase in 28 day survival. Conclusion: The tocilizumab treatment in critically ill COVID-19 patients admitted to the ICU improved the overall 28 day hospital survival, which might not be influenced by the concurrent use of other COVID-19 medical therapeutics, although further research is needed to confirm this. MDPI 2023-03-16 /pmc/articles/PMC10053430/ /pubmed/36983304 http://dx.doi.org/10.3390/jcm12062301 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Elhazmi, Alyaa
Rabie, Ahmed A.
Al-Omari, Awad
Mufti, Hani N.
Sallam, Hend
Alshahrani, Mohammed S.
Mady, Ahmed
Alghamdi, Adnan
Altalaq, Ali
Azzam, Mohamed H.
Sindi, Anees
Kharaba, Ayman
Al-Aseri, Zohair A.
Almekhlafi, Ghaleb A.
Tashkandi, Wail
Alajmi, Saud A.
Faqihi, Fahad
Alharthy, Abdulrahman
Al-Tawfiq, Jaffar A.
Melibari, Rami Ghazi
Arabi, Yaseen M.
Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title_full Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title_fullStr Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title_full_unstemmed Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title_short Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics
title_sort tocilizumab outcomes in critically ill covid-19 patients admitted to the icu and the role of non-tocilizumab covid-19-specific medical therapeutics
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053430/
https://www.ncbi.nlm.nih.gov/pubmed/36983304
http://dx.doi.org/10.3390/jcm12062301
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