1
|
Arcani R, Correard F, Suchon P, Kaplanski G, Jean R, Cauchois R, Leprince M, Arcani V, Seguier J, De Sainte Marie B, Andre B, Koubi M, Rossi P, Gayet S, Gobin N, Garrido V, Weiland J, Jouve E, Couderc AL, Villani P, Daumas A. Tocilizumab versus anakinra in COVID-19: results from propensity score matching. Front Immunol 2023; 14:1185716. [PMID: 37304271 PMCID: PMC10250610 DOI: 10.3389/fimmu.2023.1185716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background Tocilizumab and anakinra are anti-interleukin drugs to treat severe coronavirus disease 2019 (COVID-19) refractory to corticosteroids. However, no studies compared the efficacy of tocilizumab versus anakinra to guide the choice of the therapy in clinical practice. We aimed to compare the outcomes of COVID-19 patients treated with tocilizumab or anakinra. Methods Our retrospective study was conducted in three French university hospitals between February 2021 and February 2022 and included all the consecutive hospitalized patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection assessed by RT-PCR who were treated with tocilizumab or anakinra. A propensity score matching was performed to minimize confounding effects due to the non-random allocation. Results Among 235 patients (mean age, 72 years; 60.9% of male patients), the 28-day mortality (29.4% vs. 31.2%, p = 0.76), the in-hospital mortality (31.7% vs. 33.0%, p = 0.83), the high-flow oxygen requirement (17.5% vs. 18.3%, p = 0.86), the intensive care unit admission rate (30.8% vs. 22.2%, p = 0.30), and the mechanical ventilation rate (15.4% vs. 11.1%, p = 0.50) were similar in patients receiving tocilizumab and those receiving anakinra. After propensity score matching, the 28-day mortality (29.1% vs. 30.4%, p = 1) and the rate of high-flow oxygen requirement (10.1% vs. 21.5%, p = 0.081) did not differ between patients receiving tocilizumab or anakinra. Secondary infection rates were similar between the tocilizumab and anakinra groups (6.3% vs. 9.2%, p = 0.44). Conclusion Our study showed comparable efficacy and safety profiles of tocilizumab and anakinra to treat severe COVID-19.
Collapse
Affiliation(s)
- Robin Arcani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | | | - Pierre Suchon
- Hematology Laboratory, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Rodolphe Jean
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Raphael Cauchois
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marine Leprince
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Vincent Arcani
- Pharmacy Department, CHU La Timone, AP-HM, Marseille, France
| | - Julie Seguier
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Benjamin De Sainte Marie
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Baptiste Andre
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marie Koubi
- Department of Internal Medicine, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pascal Rossi
- Department of Internal Medicine, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Stéphane Gayet
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nirvina Gobin
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Victoria Garrido
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Joris Weiland
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Elisabeth Jouve
- Service Evaluation Médicale, CHU la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Department, CHU Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
| | - Patrick Villani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
| | - Aurélie Daumas
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Hafez W, Abdelrahman A. Factors Influencing Disease Stability and Response to Tocilizumab Therapy in Severe COVID-19: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081078. [PMID: 36009949 PMCID: PMC9405062 DOI: 10.3390/antibiotics11081078] [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: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: The efficacy of tocilizumab in COVID-19 has been doubted. The study aimed to investigate factors affecting disease stability and response to tocilizumab among severe COVID-19 patients. (2) Methods: This was a cohort study of 70 severe COVID-19 patients at NMC Royal Hospital, UAE, from April to June 2020. (3) Results: Elderly patients and those with cardiovascular comorbidities had a higher risk of unstable COVID-19 (p = 0.025). Regarding tocilizumab therapy timing, compared to the critical group receiving tocilizumab, the unstable severe patients receiving tocilizumab had a significantly higher rate of improvement (86%). In contrast, the late critical subgroup showed a significantly increased mortality rate (52.9%). The risk for secondary infection and adverse events following tocilizumab was higher in the late critical group than in the unstable severe and early critical groups (p = 0.024 and p = 0.006, respectively). Therapeutic doses of anticoagulation and high-dose vitamin D were correlated with better outcomes than the prophylactic dose and the treatment dose of vitamin D (p < 0.001 and p = 0.07, respectively). (4) Conclusions: elderly patients and those with cardiovascular disease developed unstable COVID-19. Tocilizumab is a potentially effective choice against severe and critical COVID-19. Early tocilizumab administration combined with therapeutic dose anticoagulation and high vitamin D doses could improve the patients’ outcomes.
Collapse
Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- The Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo 12622, Egypt
- Correspondence: ; Tel.: +971-2203-5000
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- Internal Medicine Department, Zagazig School of Medicine, Zagazig 44519, Egypt
| |
Collapse
|