The Effect of Tocilizumab in the Treatment of COVID-19 Patients: A Propensity Score-Matched and a Stabilized Inverted Probability of Treatment Weight Study (SIPTW)

Abstract

Studies disputed the use of tocilizumab in the treatment of COVID-19 patients, retrospective studies and one interventional study from the RECOVER study supported tocilizumab use, however, many other interventional and a retrospective propensity score-matched studies did not find a benefit from its use, in contrast, increased mortality was demonstrated, this study aims to add knowledge on this topic. Records for 1124 COVID-19 admitted patients were reviewed. Patients were recruited from three participating hospitals. Characteristics of all-cohort and propensity score-adjusted (PSadjusted) patients were described, data was analyzed as propensity score matching (PSM) and a stabilized inverted probability of treatment weighting (SIPTW). Management of patients was up to the treating physicians who varied in the treatment approach., the effect difference was estimated by χ2. Further, the study was analyzed as logistic regression to assure robustness of the inferred outcomes; recovery, need for home oxygen, and all-cause mortality. All-cause mortality for patients was 12.7% (143) and in ICU was 54.0% (128). In the all-cohort, there was an increase of patients' recovery in controls; 39.6% versus tocilizumab 9.9% (P<0.000). The need for home oxygen was more in tocilizumab; 59.2%, controls 38.6% (P<0.000). Mortality was higher in tocilizumab than the controls (25.4% versus 10.9%, P<0.000). Analyses as PSM-adjustment and SIPTW continued to demonstrate significantly less recovery and more mortality with using tocilizumab (P ≤ 0.002), but tocilizumab and the control did not differ significantly for the need for home oxygen therapy (49.1% vs. 48.6% respectively, P=0.945). No benefit was seen for tocilizumab in the treatment of COVID-19 patients, quite the opposite, it showed no recovery benefit, increased mortality, and did not impact the need for home oxygen.