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

2022; Elsevier BV; Volume: 117; Linguagem: Inglês

10.1016/j.ijid.2022.01.040

1878-3511

Rafael San Juan, Mario Fernández‐Ruiz, Francisco López‐Medrano, Octavio Carretero, Antonio Lalueza, Guillermo Maestro de la Calle, María Asunción Pérez‐Jacoiste Asín, Héctor Bueno, José Manuel Caro‐Teller, M. Catalán, Cristina de la Calle, Rocío García-García, Carlos F. Gómez, Rocío Laguna‐Goya, Manuel Lizasoaín, Joaquín Martínez‐López, Julia Origüen, Ángel Sevillano, Eduardo Gutiérrez, Borja de Miguel, Fernando Aguilar-Rodríguez, Patricia Parra, M. Ripoll, Tamara Ruiz-Merlo, Hernando Trujillo, José L. Pablos, Estela Paz‐Artal, Carlos Lumbreras, José María Aguado,

Long-Term Effects of COVID-19

Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients.We retrospectively analyzed a cohort of patients with severe COVID-19 who received off-label TCZ after recommendation by a local committee and were admitted to the University Hospital "12 de Octubre" until May 2020. The primary end point was a significant clinical improvement (SCI) on day 14 after administration of TCZ. Factors independently related to SCI were analyzed by multivariate logistic regression models.Of 428 (63.3%) patients treated with TCZ, 271 (63.3%) experienced SCI. After adjustment for factors related to unfavorable outcomes, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1-3.55; P = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI: 1.3-8.1; P = 0.01) were independently related to SCI. The rate of SCI significantly decreased according to the time of TCZ administration: 70.2% in the first 48 hours from admission, 58.5% on days 3-7, and 45.1% after day 7 (P = 0.03 and P = 0.001, respectively).TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission.