Neither earlier nor late tocilizumab improved outcomes in the intensive care unit patients with COVID-19 in a retrospective cohort study

Abstract

Correspondenceearly promise in retrospective studies also failed in a phase III trial in critically ill COVID-19 patients on mechanical ventilation. 12 These trials raise doubts about benefit of IL-6 blockade in COVID-19.In summary, neither earlier TCZ administration in nonintubated ICU patients with severe COVID-19 associated pneumonia nor late infusion after initiation of mechanical ventilation did reduce mortality. Unfortunately, our findings are in line with the preliminary results of phase III trials of IL-6 inhibitors in patients with severe COVID-19 pneumonia. We agree with Ramiro et al 2 that initial immunosuppressive treatment, if considered necessary in these patients, should involve widely available and inexpensive glucocorticoids, whereas IL-6 inhibitors, as chloroquine/hydroxychloroquine, 13 may be preserved for patients with rheumatic diseases in whom these medications have established efficacy.

Outcomes and risk factors for death in patients with coronavirus disease-2019 (COVID-19) pneumonia admitted to the intensive care units of an Egyptian University Hospital. A retrospective cohort study

“…To the best of our knowledge, this is the first study reporting characteristics of and outcomes from COVID-19 for patients requiring ICU admission in Egypt. Similar to previous studies from European [ 2 , 3 , 5 , 8 , 10 , 12 , [15] , [16] , [17] , [18] , 21 , 31 , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ], North American [ 4 , 6 , 7 , [24] , [25] , [26] ], and Asian [ 11 , 19 , 20 , 23 , [27] , [28] , [29] , [30] , 44 ] ICUs, more than two-thirds of our patients were male, with a high prevalence of preexisting comorbid conditions. Nonetheless, 23% of patients in our cohort did not have known comorbid conditions, suggesting that severe SARS-Cov-2 infections with a fatal outcome may also occur in otherwise healthy individuals.…”

“…As of December 21, around 75 million infections have been documented around the globe with an overall mortality rate of 2.23% [ 1 ]. Although most patients with SARS-CoV-2 infections have been reported to develop mild to moderate symptoms, patients with severe respiratory insufficiency requiring admission to the intensive care unit (ICU) are at a high risk of major morbidity and subsequently have high mortality rates [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. Several cohort studies have reported the characteristics of and outcomes from COVID-19 pneumonia in these critically ill patients [ 2 , 4 , 5 , 11 , 12 , 20 , 23 ].…”

“…Several cohort studies have reported the characteristics of and outcomes from COVID-19 pneumonia in these critically ill patients [ 2 , 4 , 5 , 11 , 12 , 20 , 23 ]. However, most of the studies published to-date, have reported on ICU cohorts from Europe [ 2 , 3 , 5 , 10 , 12 , 17 , 18 ], North America [ 4 , 6 , 7 , [24] , [25] , [26] ], and China [ 11 , 23 , [27] , [28] , [29] , [30] ], which may not reflect the global picture. Moreover, several studies have included relatively small number of patients, which may provide false estimates of outcome and disease burden in these patients [ 7 , 8 , 11 , 22 , 23 , 29 , 31 ].…”

Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19

“…The profile of patients with favorable response to TCZ therapy in our study was also defined by the absence of major underlying diseases potentially related with a worse outcome, such as active malignancy or the presence of advanced disease with severe respiratory deterioration (as indicated by higher values of CRP or LDH and lower SpO2/FiO2 ratios) (Table 6). Such factors have been previously related with poor outcome (Richardson et al, 2020, Wu et al, 2020, Zhou et al, 2020 and efficacy of TCZ has been shown to be lower in advanced stages of SARS-CoV-2-related ARDS (Moiseev et al, 2020). Age was not an independent risk factor for clinical failure in our cohort probably due to the relatively young population included (only one third over 60 years old).…”

Uso racional de tocilizumab en pacientes con COVID-19: una propuesta conciliadora

“…Sin embargo, y de acuerdo con la literatura, se han observado beneficios considerables en algunos subgrupos poblacionales de pacientes con COVID-19, aun cuando todavía es considerado prematuro obtener mayores conclusiones. [2][3][4][5][6][7] En el documento emitido por la Secretaría de Salud también se expresa que el tocilizumab no debe ser utilizado como una alternativa. En realidad, el tocilizumab no se utiliza como una alternativa, sino como un coadyuvante al uso de esteroides sistémicos.…”