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Open AccessFeature PaperArticle

Effect of Tocilizumab in Hospitalized Patients with Severe COVID-19 Pneumonia: A Case-Control Cohort Study

1
Department of Internal Medicine, Robert Ballanger Hospital, 93600 Aulnay-Sous-Bois, France
2
Research & Innovation of CMC Ambroise Paré, 92200 Neuilly-Sur-Seine, France
3
INSERM, Clinical Investigations Center Paris-Est, CIC-1901, Sorbonne Université, AP.HP. Pitié-Salpétrière, 75013 Paris, France
4
Department of Pharmacy, Robert Ballanger Hospital, 93600 Aulnay-Sous-Bois, France
5
Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP.HP. Pitié-Salpétrière, 75013 Paris, France
6
Department of Cardiology, Robert Ballanger Hospital, 93600 Aulnay-Sous-Bois, France
*
Author to whom correspondence should be addressed.
These authors equally contributed to the manuscript.
Pharmaceuticals 2020, 13(10), 317; https://doi.org/10.3390/ph13100317
Received: 17 September 2020 / Revised: 12 October 2020 / Accepted: 14 October 2020 / Published: 17 October 2020
(This article belongs to the Special Issue COVID-19 in Pharmaceuticals)
Tocilizumab, an anti-interleukin-6 receptor, administrated during the right timeframe may be beneficial against coronavirus-disease-2019 (COVID-19) pneumonia. All patients admitted for severe COVID-19 pneumonia (SpO2 ≤ 96% despite O2-support ≥ 6 L/min) without invasive mechanical ventilation were included in a retrospective cohort study in a primary care hospital. The treatment effect of a single-dose, 400 mg, of tocilizumab was assessed by comparing those who received tocilizumab to those who did not. Selection bias was mitigated using three statistical methods. Primary outcome measure was a composite of mortality and ventilation at day 28. A total of 246 patients were included (106 were treated with tocilizumab). Overall, 105 (42.7%) patients presented the primary outcome, with 71 (28.9%) deaths during the 28-day follow-up. Propensity-score-matched 84 pairs of comparable patients. In the matched cohort (n = 168), tocilizumab was associated with fewer primary outcomes than the control group (hazard ratio (HR) = 0.49 (95% confidence interval (95%CI) = 0.3–0.81), p-value = 0.005). These results were similar in the overall cohort (n = 246), with Cox multivariable analysis yielding a protective association between tocilizumab and primary outcome (adjusted HR = 0.26 (95%CI = 0.135–0.51, p = 0.0001), confirmed by inverse probability score weighting (IPSW) analysis (p < 0.0001). Analyses on mortality only, with 28 days of follow-up, yielded similar results. In this study, tocilizumab 400 mg in a single-dose was associated with improved survival without mechanical ventilation in patients with severe COVID-19. View Full-Text
Keywords: anti-interleukin-6; COVID-19; SARS CoV2; severe pneumonia; cytokine release syndrome anti-interleukin-6; COVID-19; SARS CoV2; severe pneumonia; cytokine release syndrome
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Rossi, B.; Nguyen, L.S.; Zimmermann, P.; Boucenna, F.; Dubret, L.; Baucher, L.; Guillot, H.; Bouldouyre, M.-A.; Allenbach, Y.; Salem, J.-E.; Barsoum, P.; Oufella, A.; Gros, H. Effect of Tocilizumab in Hospitalized Patients with Severe COVID-19 Pneumonia: A Case-Control Cohort Study. Pharmaceuticals 2020, 13, 317.

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