Effect of Tocilizumab in Mortality among Patients with Severe and Critical Covid-19: Experience in a Third-Level Medical Center

Abstract

Background: Trials evaluating safety and efficacy of tocilizumab in coronavirus disease 19 show contradictory results. Objective: The objective of the study was to evaluate the effect of tocilizumab in hospital mortality among patients with severe COVID-19 in a third-level medical center. Methods: This prospective cohort study included patients with severe and critical COVID-19. Primary outcome was death during hospitalization. Secondary outcomes included invasive mechanical ventilation (IMV), days on IMV, ventilator-free days (VFDs), length of hospital stay (LOS), and development of hospitalacquired infections (HAIs). Bivariate, multivariate, and propensity score matching analysis were performed. Results: During the study period, 99/794 (12%) patients received tocilizumab. Male patients, health care workers, and patients with increased inflammatory markers received tocilizumab more frequently. No difference in hospital mortality was observed between groups (34% vs. 34%, p = 0.98). Tocilizumab was not independently associated with mortality. No significant treatment effects were observed in propensity score analysis. IMV was more frequent (46% vs. 11%, p < 0.01) and LOS was longer (12 vs. 7 days, p < 0.01) in the tocilizumab group, reflecting increased severity. Although HAIs were more frequent in the tocilizumab group (22% vs. 10%, p < 0.01), no difference was seen after adjusting for IMV (38% vs. 40%, p = 0.86).Conclusions: In our study, tocilizumab was not associated with decreased hospital mortality among patients with severe COVID-19. (REV INVEST CLIN. [AHEAD OF PRINT])

Predictors of poor outcomes in young non-comorbid patients with COVID-19

“…In multivariate analysis, male sex (aOR 7.1, 95%CI 1.1-46.0, p < 0.05), D-dimer levels > 1000 ng/mL (aOR 9.0, 95%CI 1.6-49.1, p < 0.05) and RT-PCR Ct values ≤ 24 (aOR 14.3, 95%CI 2.0-101.5, p < 0.01) were independently associated with the primary outcome. Results are summarized in Table 1 24,25 .…”

“…Because age was also included in the model, the Nutri-CoV score (which uses age and pulse oximetry data for assessment) was not included in the logistic regression model. Since tocilizumab prescription was not standardized at any point during the study period and may be susceptible to selection bias 24 , it was not included in the logistic regression model. Because steroids are known to reduce COVID-19 associated mortality 25 , the variable was included in the logistic regression model.…”

Emergency Use of Tocilizumab in Moderate and Severe COVID-19 Patients over the Prevaccination Stage during the Pandemic in Mexico

“…One of them was a prospective cohort study that included 99 patients with severe and critical COVID-19 for the purpose of assessing the effect of tocilizumab on hospital mortality in severe and critical COVID-19 patients in a third-level medical center. The study found no differences between groups and mortality and concluded that tocilizumab was not associated with decreased hospital mortality [ 26 ].…”

Rural treatment of COVID-19 patients with pirfenidone, nitazoxanide and colchicine. Case series

“…Although in Mexico research was done with a mixture of ivermectin, azithromycin, montelukast, and acetylsalicylic acid [52], ours is the first report of a wide drug mixture with pirfenidone + NTZ and colchicine. Even more, different schemes have been used in Mexico City to treat COVID-19, but besides the fact that these options are very expensive, they are not associated with decreased hospital mortality [53,54].…”