Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: A retrospective cohort study with follow-up from Mumbai, India

Gokhale, Yojana; Mehta, Rakshita; Kulkarni, Uday; Karnik, Nitin; Gokhale, Sushant; Sundar, Uma; Chavan, Swati; Kor, Akshay; Thakur, Sonal; Triwedi, Tripti; Kumar, Naveen; Baveja, Sujata; Wadal, Aniket; Kolte, Shaonak; Deolankar, Aukshan; Pednekar, Suhas; Kalekar, Lalana; Padiyar, Rupal; Londhe, Charulata; Darole, Pramod; Pol, Sujata; Gokhe, Seema Bansode; Padwal, Namita; Pandey, Dharmendra; Yadav, Devendra Kumar; Joshi, Anagha; Badgujar, Harshal; Trivedi, Mayuri; Shah, Priyanshu; Bhavsar, Prerna

doi:10.21203/rs.3.rs-80152/v1

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…The majority of included studies were carried out in different hospitals from countries in America and Europe, such as the United States (US) 46,47,[51][52][53][54][55]61,67,68,70,76,82,84,[86][87][88][89][90]92,94 , Italy (ITA) 41,[43][44][45]48,49,58,60,69,77,79,91,95 , Spain (SPA) 40,42,63,64,71,75,78,83,85 , and France (FRA). 56,57,59,62,96 A lesser number was conducted in Sweden (SWE) 50 , India (IND) 72,81,…”

Section: Re Sultsmentioning

confidence: 99%

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

et al. 2021

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Introduction:The results of studies of tocilizumab (TCZ) in COVID-19 are contradictory. Our study aims to update medical evidence from controlled observational studies and randomized clinical trials (RCTs) on the use of TCZ in hospitalized patients with COVID-19. Methods:We searched the following databases from January 1, 2020 to April 13, 2021 (date of the last search): MEDLINE database through the PubMed search engine and Scopus, using the terms ("COVID-19" [Supplementary Concept]) AND "tocilizumab" [Supplementary Concept]).Results: Sixty four studies were included in the present study: 54 were controlled observational studies (50 retrospective and 4 prospective) and 10 were RCTs. The overall results provided data from 20,616 hospitalized patients with COVID-19: 7668 patients received TCZ in addition to standard of care (SOC) (including 1915 patients admitted to intensive care units (ICU) with reported mortality) and 12,948 patients only receiving SOC (including 4410 patients admitted to the ICU with reported mortality). After applying the random-effects model, the hospital-wide (including ICU) pooled mortality odds ratio (OR) of patients with COVID-19 treated with TCZ was 0.73 (95% confidence interval (CI) = 0.56-0.93). The pooled hospital-wide mortality OR was 1.25 (95% CI = 0.74-2.18) in patients admitted at conventional wards versus 0.66 (95% CI = 0.59-0.76) in patients admitted to the ICU. The pooled OR of hospitalwide mortality (including ICU) of COVID-19 patients treated with TCZ plus corticosteroids (CS) was 0.67 (95% CI = 0.54-0.84). The pooled in-hospital mortality OR was 0.71 (95% CI = 0.35-1.42) when TCZ was early administered (≤10 days from symptom onset) versus 0.83 (95% CI 0.48-1.45) for late administration (>10 days from symptom onset). The meta-analysis did not find significantly higher risk for secondary infections in COVID-19 patients treated with TCZ.Conclusions: TCZ prevented mortality in patients hospitalized for COVID-19. This benefit was seen to a greater extent in patients receiving concomitant CS and when TCZ administration occurred within the first 10 days after symptom onset.

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Section: Re Sultsmentioning

confidence: 99%

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

et al. 2021

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“…Based on rising evidence on tocilizumab efficacy, the National Institutes of Health (NIH) COVID-19 treatment guidelines recommend using a single dose of IV tocilizumab combined with steroids in hospitalized patients experiencing COVID-19 induced rapid respiratory decompensation [ 33 ]. The latest revised Saudi MOH protocol for patients with COVID-19 recommends the same dosing regimen as the NIH within 24 h of ICU admission for patients exhibiting hyperinflammatory symptoms on invasive or non-invasive MV, high flow nasal cannula in combination with dexamethasone [ 31 ]. It is noteworthy that practice guidelines previously recommended repeating the dose of tocilizumab within 12 h during the study period [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Single versus multiple doses of Tocilizumab in critically ill patients with coronavirus disease 2019 (COVID-19): A two-center, retrospective cohort study

Sulaiman

Aljuhani

Salah

et al. 2021

Journal of Critical Care

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Purpose To evaluate the effectiveness and safety of the optimal tocilizumab dosing regimen. Methods A two-center, retrospective cohort study, for COVID19 critically ill patients admitted to the intensive care units (ICUs). We included critically ill patients aged 18 years or older who received tocilizumab during ICU stay. Patients were divided into two groups based on the number of the received tocilizumab doses. The primary outcome was the in-hospital and 30-day mortality. Propensity score (PS) matching was used (1:1 ratio) based on the selected criteria. Results A total of 298 patients were included in the study; 70.4% (210 patients) received a single dose of tocilizumab. After adjusting for possible confounders, the 30-day mortality (HR 0.79 95% CI 0.43–1.45 P = 0.44) and in-hospital mortality (HR 0.81; 95% CI 0.46–1.49; P = 0.53) were not significantly different between the two groups. On the flip side, patients who received multiple doses had higher pneumonia odds than a single dose (OR 3.81; 95% CI 1.79–8.12 P = 0.0005). Conclusion Repeating tocilizumab doses were not associated with a mortality benefit in COVID-19 critically ill patients, but it was associated with higher odds of pneumonia compared to a single dose.

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“…In the literature, we came across case reports about COVIDrelated DM. According to Gokhale et al (21), a surge in the incidence of DM was noted in 2020 during the months of April-August-the period coinciding with the occurrence of the COVID-19 pandemic in the City of Mumbai. Usually, they identified one to two patients of DM per year.…”

Section: Literature Reviewmentioning

confidence: 99%

Case report: Unusual patient with dermatomyositis associated with SARS-CoV-2 infection

Niedzielska¹,

Chaszczewska-Markowska

Chojdak-Łukasiewicz

et al. 2023

Front. Neurol.

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a major challenge for clinicians. SARS-CoV-2 infection results in coronavirus disease 2019 (COVID-19), and it is best known for its respiratory symptoms. It can also result in several extrapulmonary manifestations such as neurological complications potentially experienced during the course of COVID-19. The association of dermatomyositis (DM) with COVID-19 pathogenesis has not been well-studied. This study aimed to present a previously healthy 37-year-old man, a soldier by profession, with symptoms of DM on the 4th day from the onset of COVID-19. The patient presented DM symptoms with both skin and muscle manifestations. The patient suffered from cough, fever, and fatigue to begin with, and reverse-transcription polymerase chain reaction (RT-PCR) reported positive for SARS-CoV-2 infection. The laboratory findings showed, intra alia, elevated muscle enzymes CK 8253 U/l (N: <145 U/l), a positive test for myositis-specific autoantibodies (anti-Mi-2), electrodiagnostic tests exhibited features of myopathy, with the presence of muscle and skin symptoms. The patient improved with corticosteroids and immunosuppressive agent therapy. In summary, the association between COVID-19 and the development of multi-system autoimmune disorders such as DM remains unclear. Nevertheless, viral infections such as SARS-CoV-2 may likely serve as a trigger.

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Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: A retrospective cohort study with follow-up from Mumbai, India

Cited by 5 publications

References 9 publications

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

Single versus multiple doses of Tocilizumab in critically ill patients with coronavirus disease 2019 (COVID-19): A two-center, retrospective cohort study

Case report: Unusual patient with dermatomyositis associated with SARS-CoV-2 infection

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