Early use of tocilizumab in solid organ transplant recipients with COVID‐19: A retrospective cohort study in Saudi Arabia

Abstract

Background Tocilizumab was studied to reduce cytokine syndrome in patients with severe COVID‐19 pneumonia in solid organ transplant (SOT) recipients with conflicting results. We aim to study the early use of tocilizumab in SOT with COVID‐19 pneumonia on low flow oxygen. Methods This is a retrospective cohort study that was conducted in two transplant centers in Saudi Arabia among 46 SOT with COVID‐19 comparing 21 patients who received tocilizumab to 25 patients who received standard of care. Their clinical characteristics and outcomes were described. Results Compared to patients who received standard of care, patients in the tocilizumab group were older (60.2 ± 12.8 vs. 48.6 ± 12.3, p = .003), had higher ferritin (862.1 ± 919.1 vs. 414 ± 447.3, p = .025) and C‐reactive protein (CRP) (85 ± 83.1 vs. 42.9 ± 57.3, p = .012). More patients in the tocilizumab group required high flow oxygen (38.1% vs. 8.0%, p = .028) compared to patients on standard of care. There were no differences in mortality or mechanical ventilation requirement. Hospital stay was significantly shorter in the tocilizumab group than the standard of care group (9.6 ± 7.4 vs. 20.7 ± 11.7, p < .001). Conclusions Early use of tocilizumab in SOT was associated with a shorter hospital stay. There was no difference in mortality rate and the requirement for mechanical ventilation in both groups.

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

“…Pereira et al 84 performed a propensity-matched study in which tocilizumab was not associated with better survival, or other measures of improvement. Recently, Yamani et al 85 have compared SOT recipients in Saudi Arabia who did or did not receive tocilizumab (25 versus 21 patients respectively). Despite being older and having higher inflammatory markers at presentation, patients who received tocilizumab had a shorter hospital stay, although there were no differences in mortality or mechanical ventilation.…”

“…Despite being older and having higher inflammatory markers at presentation, patients who received tocilizumab had a shorter hospital stay, although there were no differences in mortality or mechanical ventilation. 85 Although it has been difficult to discern a consistent benefit in the literature, some clinicians continue to turn to tocilizumab in particular situations, for example if a patient is in the upswing of the inflammatory phase, and is not responding to dexamethasone.…”

Efficacy and safety of sotrovimab in patients with COVID‐19: A rapid review and meta‐analysis

“…Since the beginning of the coronavirus disease 2019 (COVID‐19) pandemic, many therapeutic interventions have been introduced and evaluated 1–3 . The current evidence shows the effectiveness of monoclonal antibody (mAb) therapy in the prevention and treatment of COVID‐19 4 .…”

“…Since the beginning of the coronavirus disease 2019 (COVID‐19) pandemic, many therapeutic interventions have been introduced and evaluated. 1 , 2 , 3 The current evidence shows the effectiveness of monoclonal antibody (mAb) therapy in the prevention and treatment of COVID‐19. 4 Several anti‐severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) mAb therapies, such as casirivimab/imdevimab, 5 , 6 , 7 bamlanivimab, 8 bamlanivimab/etesevimab, 9 , 10 , 11 and sotrovimab 4 , 12 have been proposed as promising potential treatments for patients with COVID‐19.…”

Coronavirus Disease 2019 Management Strategies in Solid Organ Transplant Recipients

“…Reassuringly, there was no increased of secondary infections 75 . Another cohort study of 21 patients that received tocilizumab matched to standard of care patients also found no clear difference in mortality or mechanical ventilation requirement, but they did find that the hospital stay was shorter in the tocilizumab group 76 . These studies are limited by their retrospective study design and small cohort of SOT populations.…”