Background
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.
Methods
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.
Results
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).
Conclusions
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.
Key Points
Question
What is the ability of a host gene expression test to accurately discriminate bacterial from viral infection among patients with acute respiratory illness?
Findings
In this diagnostic study involving analysis of 616 children and adults with febrile acute respiratory illness of 7 or fewer days’ duration, the host response bacterial/viral test had up to 90% sensitivity, 82% specificity, and 98% negative predictive value for bacterial infection, which was significantly better than procalcitonin measurement.
Meaning
The study’s findings suggest that an accurate point-of-need host response test with high negative predictive value may identify patients unlikely to have bacterial infection, offering a better antibiotic stewardship strategy than is currently available.
The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy.
Neurocysticercosis (NCC) is a major cause of neurologic disease and epilepsy worldwide. Clinical manifestations of NCC are primarily due to the inflammatory response against degenerating cysts of the Taenia solium tapeworm, which occurs when cysts lose their ability to evade host immune responses. Patients with subarachnoid or severe parenchymal NCC may also develop chronic inflammation requiring long-term immunosuppression. 2 Corticosteroids are first-line anti-inflammatory agents in NCC; however, prolonged treatment is associated with multiorgan toxicity. While recent guidelines recommend methotrexate (MTX) as a steroid-sparing agent (SSA), when to initiate SSAs and alternatives to MTX in the case of failure or intolerance remain unspecified. 1 Here, we describe 3 patients followed at a single hospital for NCC-associated inflammation requiring SSAs.
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