What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak.
<h4>Background</h4>Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease.<h4>Methods</h4>In this retrospective analysis of patients wit...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0249349&type=printable |
| _version_ | 1826554418229673984 |
|---|---|
| author | Monica Mehta Lawrence J Purpura Thomas H McConville Matthew J Neidell Michaela R Anderson Elana J Bernstein Donald E Dietz Justin Laracy Shauna H Gunaratne Emily Happy Miller Jennifer Cheng Jason Zucker Shivang S Shah Shaoli Chaudhuri Christian A Gordillo Shreena R Patel Tai Wei Guo Lara E Karaaslan Ran Reshef Benjamin A Miko Joan M Bathon Marcus R Pereira Anne-Catrin Uhlemann Michael T Yin Magdalena E Sobieszczyk |
| author_facet | Monica Mehta Lawrence J Purpura Thomas H McConville Matthew J Neidell Michaela R Anderson Elana J Bernstein Donald E Dietz Justin Laracy Shauna H Gunaratne Emily Happy Miller Jennifer Cheng Jason Zucker Shivang S Shah Shaoli Chaudhuri Christian A Gordillo Shreena R Patel Tai Wei Guo Lara E Karaaslan Ran Reshef Benjamin A Miko Joan M Bathon Marcus R Pereira Anne-Catrin Uhlemann Michael T Yin Magdalena E Sobieszczyk |
| author_sort | Monica Mehta |
| collection | DOAJ |
| description | <h4>Background</h4>Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease.<h4>Methods</h4>In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test.<h4>Results</h4>We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168).<h4>Conclusions</h4>There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab. |
| first_indexed | 2024-12-13T11:14:57Z |
| format | Article |
| id | doaj.art-5075db336f054b76ac431f1a9fc9e285 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T07:40:36Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-5075db336f054b76ac431f1a9fc9e2852025-03-03T05:35:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01164e024934910.1371/journal.pone.0249349What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak.Monica MehtaLawrence J PurpuraThomas H McConvilleMatthew J NeidellMichaela R AndersonElana J BernsteinDonald E DietzJustin LaracyShauna H GunaratneEmily Happy MillerJennifer ChengJason ZuckerShivang S ShahShaoli ChaudhuriChristian A GordilloShreena R PatelTai Wei GuoLara E KaraaslanRan ReshefBenjamin A MikoJoan M BathonMarcus R PereiraAnne-Catrin UhlemannMichael T YinMagdalena E Sobieszczyk<h4>Background</h4>Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease.<h4>Methods</h4>In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test.<h4>Results</h4>We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168).<h4>Conclusions</h4>There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0249349&type=printable |
| spellingShingle | Monica Mehta Lawrence J Purpura Thomas H McConville Matthew J Neidell Michaela R Anderson Elana J Bernstein Donald E Dietz Justin Laracy Shauna H Gunaratne Emily Happy Miller Jennifer Cheng Jason Zucker Shivang S Shah Shaoli Chaudhuri Christian A Gordillo Shreena R Patel Tai Wei Guo Lara E Karaaslan Ran Reshef Benjamin A Miko Joan M Bathon Marcus R Pereira Anne-Catrin Uhlemann Michael T Yin Magdalena E Sobieszczyk What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. PLoS ONE |
| title | What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. |
| title_full | What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. |
| title_fullStr | What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. |
| title_full_unstemmed | What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. |
| title_short | What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. |
| title_sort | what about tocilizumab a retrospective study from a nyc hospital during the covid 19 outbreak |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0249349&type=printable |
| work_keys_str_mv | AT monicamehta whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT lawrencejpurpura whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT thomashmcconville whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT matthewjneidell whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT michaelaranderson whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT elanajbernstein whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT donaldedietz whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT justinlaracy whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT shaunahgunaratne whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT emilyhappymiller whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT jennifercheng whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT jasonzucker whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT shivangsshah whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT shaolichaudhuri whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT christianagordillo whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT shreenarpatel whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT taiweiguo whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT laraekaraaslan whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT ranreshef whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT benjaminamiko whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT joanmbathon whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT marcusrpereira whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT annecatrinuhlemann whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT michaeltyin whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak AT magdalenaesobieszczyk whatabouttocilizumabaretrospectivestudyfromanychospitalduringthecovid19outbreak |