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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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/6/2301 |
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| author | Alyaa Elhazmi Ahmed A. Rabie Awad Al-Omari Hani N. Mufti Hend Sallam Mohammed S. Alshahrani Ahmed Mady Adnan Alghamdi Ali Altalaq Mohamed H. Azzam Anees Sindi Ayman Kharaba Zohair A. Al-Aseri Ghaleb A. Almekhlafi Wail Tashkandi Saud A. Alajmi Fahad Faqihi Abdulrahman Alharthy Jaffar A. Al-Tawfiq Rami Ghazi Melibari Yaseen M. Arabi |
| author_facet | Alyaa Elhazmi Ahmed A. Rabie Awad Al-Omari Hani N. Mufti Hend Sallam Mohammed S. Alshahrani Ahmed Mady Adnan Alghamdi Ali Altalaq Mohamed H. Azzam Anees Sindi Ayman Kharaba Zohair A. Al-Aseri Ghaleb A. Almekhlafi Wail Tashkandi Saud A. Alajmi Fahad Faqihi Abdulrahman Alharthy Jaffar A. Al-Tawfiq Rami Ghazi Melibari Yaseen M. Arabi |
| author_sort | Alyaa Elhazmi |
| collection | DOAJ |
| 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%) (<i>p</i>-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%) (<i>p</i>-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)) (<i>p</i> = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61–1.9)) (<i>p</i> = 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. |
| first_indexed | 2024-03-11T06:21:45Z |
| format | Article |
| id | doaj.art-10edf6a8c4534e91818a4f28c219402e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:21:45Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-10edf6a8c4534e91818a4f28c219402e2023-11-17T11:51:00ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126230110.3390/jcm12062301Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical TherapeuticsAlyaa Elhazmi0Ahmed A. Rabie1Awad Al-Omari2Hani N. Mufti3Hend Sallam4Mohammed S. Alshahrani5Ahmed Mady6Adnan Alghamdi7Ali Altalaq8Mohamed H. Azzam9Anees Sindi10Ayman Kharaba11Zohair A. Al-Aseri12Ghaleb A. Almekhlafi13Wail Tashkandi14Saud A. Alajmi15Fahad Faqihi16Abdulrahman Alharthy17Jaffar A. Al-Tawfiq18Rami Ghazi Melibari19Yaseen M. Arabi20Department of Critical Care, Dr. Sulaiman Al-Habib Medical Group, Riyadh 11643, Saudi ArabiaCritical Care Department, King Saud Medical City, Riyadh 11196, Saudi ArabiaResearch Center, Dr. Sulaiman Alhabib Medical Group, Riyadh 11643, Saudi ArabiaSection of Cardiac Surgery, Department of Cardiac Sciences, King Faisal Cardiac Center, King Abdulaziz Medical City, MNGHA-WR, Jeddah 21423, Saudi ArabiaDepartment of Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah 23431, Saudi ArabiaDepartment of Emergency and Critical Care, King Fahad Hospital of the University, Dammam University, Al Khobar 31952, Saudi ArabiaCritical Care Department, King Saud Medical City, Riyadh 11196, Saudi ArabiaPrince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi ArabiaPrince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi ArabiaIntensive Care Department, King Abdullah Medical Complex, Jeddah 23816, Saudi ArabiaDepartment of Medicine, Intensive Care, King Abdulaziz University, Jeddah 21589, Saudi ArabiaDepartment of Critical Care, King Fahad Hospital, Al Medina Al Munawara 41477, Saudi ArabiaDepartments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh 11451, Saudi ArabiaPrince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi ArabiaDepartment of Adult Critical Care, Fakeeh Care Group, Jeddah 23323, Saudi ArabiaPrince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi ArabiaDepartment of Critical Care, Dr. Sulaiman Al-Habib Medical Group, Riyadh 11643, Saudi ArabiaCritical Care Department, King Saud Medical City, Riyadh 11196, Saudi ArabiaInfectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran 34464, Saudi ArabiaDepartment of Critical Care, King Abdullah Medical City, Makah 24246, Saudi ArabiaIntensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi ArabiaBackground: 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%) (<i>p</i>-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%) (<i>p</i>-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)) (<i>p</i> = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61–1.9)) (<i>p</i> = 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.https://www.mdpi.com/2077-0383/12/6/2301tocilizumabCOVID-19outcomepropensity-matching |
| spellingShingle | Alyaa Elhazmi Ahmed A. Rabie Awad Al-Omari Hani N. Mufti Hend Sallam Mohammed S. Alshahrani Ahmed Mady Adnan Alghamdi Ali Altalaq Mohamed H. Azzam Anees Sindi Ayman Kharaba Zohair A. Al-Aseri Ghaleb A. Almekhlafi Wail Tashkandi Saud A. Alajmi Fahad Faqihi Abdulrahman Alharthy Jaffar A. Al-Tawfiq Rami Ghazi Melibari Yaseen M. Arabi Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics Journal of Clinical Medicine tocilizumab COVID-19 outcome propensity-matching |
| 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 | tocilizumab COVID-19 outcome propensity-matching |
| url | https://www.mdpi.com/2077-0383/12/6/2301 |
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