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Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure

PURPOSE: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the s...

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Autores principales: Chung, Juri, Brosnahan, Shari B., Islam, Shahidul, Altshuler, Diana, Spiegler, Peter, Li, Wai Kin, Wang, Wai Man, Chen, Xian Jie Cindy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084735/
https://www.ncbi.nlm.nih.gov/pubmed/37043893
http://dx.doi.org/10.1016/j.jcrc.2023.154291
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author Chung, Juri
Brosnahan, Shari B.
Islam, Shahidul
Altshuler, Diana
Spiegler, Peter
Li, Wai Kin
Wang, Wai Man
Chen, Xian Jie Cindy
author_facet Chung, Juri
Brosnahan, Shari B.
Islam, Shahidul
Altshuler, Diana
Spiegler, Peter
Li, Wai Kin
Wang, Wai Man
Chen, Xian Jie Cindy
author_sort Chung, Juri
collection PubMed
description PURPOSE: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the same median dose of steroids. MATERIALS/METHODS: A retrospective, multihospital observational study of COVID-19 patients who received tocilizumab in conjunction with steroids between March 2020 and August 2021 was conducted. RESULTS: A total of 407 patients were analyzed with low dose group being significantly more ill at baseline as a higher percentage of patients received vasopressors, were admitted to the ICU and on mechanical ventilation. In the propensity-matched analysis, both groups receiving a median dexamethasone equivalent dose of 10 mg showed no difference in 28-day mortality (p = 0.613). The high dose group had a higher rate of fungal and viral infections. CONCLUSION: Compared to low dose tocilizumab, the high dose did not provide additional efficacy and mortality benefit but resulted in higher fungal and viral infections. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients.
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spelling pubmed-100847352023-04-11 Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure Chung, Juri Brosnahan, Shari B. Islam, Shahidul Altshuler, Diana Spiegler, Peter Li, Wai Kin Wang, Wai Man Chen, Xian Jie Cindy J Crit Care Article PURPOSE: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the same median dose of steroids. MATERIALS/METHODS: A retrospective, multihospital observational study of COVID-19 patients who received tocilizumab in conjunction with steroids between March 2020 and August 2021 was conducted. RESULTS: A total of 407 patients were analyzed with low dose group being significantly more ill at baseline as a higher percentage of patients received vasopressors, were admitted to the ICU and on mechanical ventilation. In the propensity-matched analysis, both groups receiving a median dexamethasone equivalent dose of 10 mg showed no difference in 28-day mortality (p = 0.613). The high dose group had a higher rate of fungal and viral infections. CONCLUSION: Compared to low dose tocilizumab, the high dose did not provide additional efficacy and mortality benefit but resulted in higher fungal and viral infections. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients. Elsevier Inc. 2023-08 2023-04-10 /pmc/articles/PMC10084735/ /pubmed/37043893 http://dx.doi.org/10.1016/j.jcrc.2023.154291 Text en © 2023 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Chung, Juri
Brosnahan, Shari B.
Islam, Shahidul
Altshuler, Diana
Spiegler, Peter
Li, Wai Kin
Wang, Wai Man
Chen, Xian Jie Cindy
Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title_full Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title_fullStr Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title_full_unstemmed Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title_short Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure
title_sort low dose vs high dose tocilizumab in covid-19 patients with hypoxemic respiratory failure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084735/
https://www.ncbi.nlm.nih.gov/pubmed/37043893
http://dx.doi.org/10.1016/j.jcrc.2023.154291
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