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The safety and effectiveness of tocilizumab in older adult critically ill patients with COVID-19: a multicenter, cohort study

OBJECTIVES: Evidence supports tocilizumab (TCZ) benefit and safety in adult patients with severe COVID-19. However, its effectiveness in critically ill older adult patients remains questionable. Thus, the study aimed to evaluate the safety and effectiveness of TCZ in older critically ill patients wi...

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Detalles Bibliográficos
Autores principales: Korayem, Ghazwa B., Aljuhani, Ohoud, Altebainawi, Ali F., Shaya, Abdulrahman I. Al, Alnajjar, Lina I., Alissa, Abdulrahman, Aldhaeefi, Mohammed, Kensara, Raed, Al Muqati, Hessa, Alhuwahmel, Abdulmohsen, Alhuthaili, Omar, Vishwakarma, Ramesh, Aldardeer, Namareq, Eljaaly, Khalid, Alharbi, Aisha, Harbi, Shmeylan Al, Katheri, Abdulmalik Al, Bekairy, Abdulkareem M. Al, Aljedai, Ahmed, Al Sulaiman, Khalid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121644/
https://www.ncbi.nlm.nih.gov/pubmed/35605948
http://dx.doi.org/10.1016/j.ijid.2022.05.038
Descripción
Sumario:OBJECTIVES: Evidence supports tocilizumab (TCZ) benefit and safety in adult patients with severe COVID-19. However, its effectiveness in critically ill older adult patients remains questionable. Thus, the study aimed to evaluate the safety and effectiveness of TCZ in older critically ill patients with COVID-19. METHODS: A multicenter, retrospective study for all critically ill older adults (aged ≥65 years) with confirmed COVID-19 infection and admitted to the intensive care units (ICUs). Eligible patients were categorized into two groups based on TCZ use during ICU stay (control vs TCZ). Propensity score (PS) matching was used (1:1 ratio) based on the selected criteria. The primary outcome was the in-hospital mortality. RESULTS: A total of 368 critically ill older adult patients were included in the study. Fifty one patients (13.8%) received TCZ. The in-hospital mortality was lower in the TCZ group (HR 0.41; 95% CI 0.22–0.76, P-value = 0.005). Patients who received TCZ had lower odds of respiratory failure requiring mechanical ventilation (OR [95% CI]: 0.32 [0.10–0.98], P-value = 0.04). No statistically significant differences were found between the two groups for 30-days mortality, ventilator-free days, length of stay, and complications during ICU stay. CONCLUSION: Tocilizumab use in critically ill older adult patients with COVID-19 is associated with lower in-hospital mortality and a similar safety profile.