Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study
Abstract COVID-19 is associated with higher inflammatory markers, illness severity and mortality in males compared to females. Differences in immune responses to COVID-19 may underpin sex- specific outcome differences. We hypothesised that anti-IL-6 receptor monoclonal antibodies are associated with...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-08-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-40744-y |
| _version_ | 1827634405737234432 |
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| author | Dan F. Stein Conor Foley Matt Byott Eleni Nastouli Gareth Ambler Nishkantha Arulkumaran |
| author_facet | Dan F. Stein Conor Foley Matt Byott Eleni Nastouli Gareth Ambler Nishkantha Arulkumaran |
| author_sort | Dan F. Stein |
| collection | DOAJ |
| description | Abstract COVID-19 is associated with higher inflammatory markers, illness severity and mortality in males compared to females. Differences in immune responses to COVID-19 may underpin sex- specific outcome differences. We hypothesised that anti-IL-6 receptor monoclonal antibodies are associated with heterogenous treatment effects between male and female patients. We conducted a retrospective cohort study assessing the interaction between biological sex and anti-IL-6 receptor antibody treatment with respect to hospital mortality or progression of respiratory failure. We used a Cox proportional hazards regression model to adjust for age, ethnicity, steroid use, baseline C-reactive protein, and COVID-19 variant. We included 1274 patients, of which 58% were male and 15% received anti-IL-6 receptor antibodies. There was a significant interaction between sex and anti-IL-6 receptor antibody use on progression to respiratory failure or death (p = 0.05). For patients who did not receive anti-IL-6 receptor antibodies, the risk of death was slightly higher in males (HR = 1.13 (0.72–1.79)), whereas in patients who did receive anti-IL-6 receptor antibodies, the risk was lower in males (HR = 0.65 (0.32–1.33)). There was a heterogenous treatment effect with anti-IL-6 receptor antibodies between males and females; with anti-IL-6 receptor antibody use having a greater benefit in preventing progression to respiratory failure or death in males (p = 0.05). |
| first_indexed | 2024-03-09T15:13:50Z |
| format | Article |
| id | doaj.art-94684bcc3ebb45ef99a63d99ab22f062 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-09T15:13:50Z |
| publishDate | 2023-08-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-94684bcc3ebb45ef99a63d99ab22f0622023-11-26T13:14:35ZengNature PortfolioScientific Reports2045-23222023-08-011311710.1038/s41598-023-40744-yBiological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort studyDan F. Stein0Conor Foley1Matt Byott2Eleni Nastouli3Gareth Ambler4Nishkantha Arulkumaran5Institute of Health Informatics, University College LondonInstitute of Health Informatics, University College LondonAdvanced Pathogen Diagnostics Unit, Department of Clinical Virology, UCL Hospitals NHS TrustAdvanced Pathogen Diagnostics Unit, Department of Clinical Virology, UCL Hospitals NHS TrustDepartment of Statistical Science, University College LondonBloomsbury Institute of Intensive Care Medicine, University College LondonAbstract COVID-19 is associated with higher inflammatory markers, illness severity and mortality in males compared to females. Differences in immune responses to COVID-19 may underpin sex- specific outcome differences. We hypothesised that anti-IL-6 receptor monoclonal antibodies are associated with heterogenous treatment effects between male and female patients. We conducted a retrospective cohort study assessing the interaction between biological sex and anti-IL-6 receptor antibody treatment with respect to hospital mortality or progression of respiratory failure. We used a Cox proportional hazards regression model to adjust for age, ethnicity, steroid use, baseline C-reactive protein, and COVID-19 variant. We included 1274 patients, of which 58% were male and 15% received anti-IL-6 receptor antibodies. There was a significant interaction between sex and anti-IL-6 receptor antibody use on progression to respiratory failure or death (p = 0.05). For patients who did not receive anti-IL-6 receptor antibodies, the risk of death was slightly higher in males (HR = 1.13 (0.72–1.79)), whereas in patients who did receive anti-IL-6 receptor antibodies, the risk was lower in males (HR = 0.65 (0.32–1.33)). There was a heterogenous treatment effect with anti-IL-6 receptor antibodies between males and females; with anti-IL-6 receptor antibody use having a greater benefit in preventing progression to respiratory failure or death in males (p = 0.05).https://doi.org/10.1038/s41598-023-40744-y |
| spellingShingle | Dan F. Stein Conor Foley Matt Byott Eleni Nastouli Gareth Ambler Nishkantha Arulkumaran Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study Scientific Reports |
| title | Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study |
| title_full | Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study |
| title_fullStr | Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study |
| title_full_unstemmed | Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study |
| title_short | Biological sex is associated with heterogeneous responses to IL-6 receptor inhibitor treatment in COVID-19—A retrospective cohort study |
| title_sort | biological sex is associated with heterogeneous responses to il 6 receptor inhibitor treatment in covid 19 a retrospective cohort study |
| url | https://doi.org/10.1038/s41598-023-40744-y |
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