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MacGregor F, Oprey A, Caulfield C, MacTavish P, Lowrie R, Henderson P. Does timing of tocilizumab administration affect mortality in COVID-19? A Scottish multicentre retrospective cohort study. BMJ Open Respir Res 2024; 11:e002264. [PMID: 39214629 PMCID: PMC11367351 DOI: 10.1136/bmjresp-2023-002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The optimal timing of tocilizumab treatment during the disease course of COVID-19 has yet to be adequately defined in the context of randomised controlled trials and the effect of tocilizumab on real-world populations remains unclear. We examined the effect of different timing of tocilizumab, on mortality, in a cohort of adults with COVID-19. METHODS All adults (≥18 years old) with confirmed COVID-19 admitted to four hospitals in the West of Scotland between 8 January 2021 and 31 March 2021 and who received tocilizumab were included in a retrospective observational cohort study. Patients were assigned to either an early (day of admission or first day after admission) or late (days 2-7 of admission) cohort based on tocilizumab initiation. The primary outcome was 90-day all-cause mortality in early versus late cohorts. Secondary outcomes were 28 and 180-day all-cause mortality. RESULTS 203 patients were included in the analysis (138 in the early cohort, 65 in the late cohort). Mortality in 90 days in the early cohort was 22% (n=30) compared with 45% (n=29) in the late cohort (p<0.001). The adjusted mortality was significantly higher in the late cohort compared with the early cohort (adjusted OR: 3.33; 95% CI: 1.29 to 8.54; p=0.012). The secondary outcomes demonstrated the same effect with higher rates of death in 28 days (late cohort adjusted OR: 3.28; 95% CI: 1.23 to 8.75; p=0.018) and 180 days (late cohort adjusted OR: 3.70; 95% CI: 1.45 to 9.45; p=0.006). The effect was seen whether the outcome was adjusted or unadjusted. CONCLUSION Early administration of tocilizumab within the first 2 days of hospitalisation was associated with a significant survival benefit compared with late exposure. Late administration was associated with particularly high mortality. The observed association may be a result of residual confounders and further research is needed.
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Affiliation(s)
- Fiona MacGregor
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alison Oprey
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Carolyn Caulfield
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Pamela MacTavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Richard Lowrie
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | - Philip Henderson
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Kohler K, Conway Morris A. GM-CSF targeting in COVID-19: an approach based on fragile foundations. Eur Respir J 2023; 61:13993003.02091-2022. [PMID: 36396141 PMCID: PMC9686318 DOI: 10.1183/13993003.02091-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) arises as a result of a pathological inflammatory response following infection with the coronavirus SARS-CoV-2. Although the majority of people infected with this virus will experience minimal or mild symptoms, a proportion will go on to develop more severe disease requiring hospitalisation and oxygen therapy. The most severe forms produce acute respiratory failure, necessitating mechanical ventilation or extracorporeal membrane oxygenation (ECMO). The advent of SARS-CoV-2 vaccination has substantially altered the risk profile of COVID-19, with marked reductions in the severity of illness and hospitalisation. However, for unvaccinated patients and those who do not mount an effective immune response to vaccination, it remains a potentially lethal infection. Trials of anti-GM-CSF therapies in COVID-19 show divergent results; this may be explained by underlying biology and the fragility of the study findings. Further investigation of the pathophysiology of COVID-19 is required to better target therapies.http://bit.ly/3O1AuIo
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Affiliation(s)
- Katharina Kohler
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK
- John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
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Effect of Tocilizumab on Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta or Omicron Variants: A Propensity-Matched Analysis in Nimes University Hospital, France. Antibiotics (Basel) 2023; 12:antibiotics12010088. [PMID: 36671288 PMCID: PMC9854884 DOI: 10.3390/antibiotics12010088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/25/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
We aimed to assess the factors associated with mortality in patients treated with tocilizumab for a SARS-CoV-2 pneumonia due to the delta or omicron variants of concern (VOC) and detect an effect of tocilizumab on mortality. We conducted a prospective cohort study in a tertiary hospital from 1 August 2021 to 31 March 2022 including patients with severe COVID-19, treated with tocilizumab. Factors associated with mortality were assessed in a Cox model; then, the 60-day mortality rates of COVID-19 patients treated with standard of care (SoC) +/- tocilizumab were compared after 1:1 propensity score matching. The mortality rate was 22% (N = 26/118) and was similar between delta and omicron cases (p = 0.6). The factors independently associated with mortality were age (HR 1.06; 95% CI (1.02-1.11), p = 0.002), Charlson index (HR 1.33; 95% CI (1.11-1.6), p = 0.002), WHO-CPS (HR 2.56; 95% CI (1.07-6.22) p = 0.03), and tocilizumab infusion within the first 48 h following hospital admission (HR 0.37, 95% CI (0.14-0.97), p = 0.04). No significant differences in mortality between the tocilizumab plus SoC and SoC alone groups (p = 0.5) were highlighted. However, the patients treated with tocilizumab within the 48 h following hospital admission had better survival (p = 0.04). In conclusion, our results suggested a protective effect on mortality of the early administration of tocilizumab in patients with severe COVID-19 regardless of the VOC involved.
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Pagkratis K, Chrysikos S, Antonakis E, Pandi A, Kosti CN, Markatis E, Hillas G, Digalaki A, Koukidou S, Chaini E, Afthinos A, Dimakou K, Papanikolaou IC. Predictors of Mortality in Tocilizumab-Treated Severe COVID-19. Vaccines (Basel) 2022; 10:vaccines10060978. [PMID: 35746585 PMCID: PMC9230711 DOI: 10.3390/vaccines10060978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8 mg/kg intravenously single dose) for severe progressive COVID-19. Results: Of 121 subjects, 62% were males, and 9% were fully vaccinated. Ninety-six (79.4%) survived, and 25 died (20.6%). Compared to survivors (S), nonsurvivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (Charlson comorbidity index 2 versus 5) and had higher rates of intubation/mechanical ventilation (p < 0.05). On admission, NS had a lower PO2/FiO2 ratio, higher blood ferritin, and higher troponin, and on clinical progression (day of tocilizumab treatment), NS had a lower PO2/FiO2 ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan, and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO2/FiO2 ratio and LDH as predictors of intubation; PO2/FiO2 ratios, LDH, and central lung disease on radiology as predictors of noninvasive ventilation (NIV) (a < 0.05). The log-rank test of mortality yielded the same results (p < 0.001). ROC analysis of the above predictors in a separate validation cohort yielded significant results. Conclusions: Older age and high serum LDH levels are predictors of mortality in tocilizumab-treated severe COVID-19 patients. Hypoxia levels, LDH, and central pulmonary involvement radiologically are associated with intubation and NIV.
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Affiliation(s)
- Konstantinos Pagkratis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Serafeim Chrysikos
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Emmanouil Antonakis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Aggeliki Pandi
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Chrysavgi Nikolaou Kosti
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Eleftherios Markatis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Georgios Hillas
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Antonia Digalaki
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Sofia Koukidou
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Eleftheria Chaini
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Andreas Afthinos
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Ilias C. Papanikolaou
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
- Correspondence: ; Tel.: +30-266-136-0694; Fax.: +30-266-136-0488
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Fedorchenko Y, Zimba O. CYTOKINES AS POTENTIAL MARKERS OF COVID-19 SEVERITY AND OUTCOMES. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2022. [DOI: 10.47316/cajmhe.2022.3.1.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The continual propagation of SARS-CoV-2 has changed health care systems globally. Ranging degrees of clinical severity in COVID-19 patients have been noted in numerous literature sources. Cytokines play a crucial role in the development of key immunological processes in COVID-19. SARS-CoV-2 causes imbalance of the immune system and might culminate in cytokine storm and multiple organ involvement. The prevailing role of some special cytokines might serve as indicators of disease severity. Further stratification of patients in the context of specific cytokines can be beneficial for diagnosing disease stages. It can prevent critical states owing to timely diagnosis and targeted therapy. Targeting peculiar cytokines can markedly reduce complications. The aim of this article is to comprehensively overview the role of the main cytokines in COVID-19 pathogenesis and distinguish prognostic factors. Insights into specific cytokine involvement in COVID-19 pathogenesis may open new avenues for diagnosing hyperinflammatory COVID-19, predicting its outcomes and providing individualized cytokine-targeted therapeutic approaches.
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