학술논문
Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19
Document Type
article
Author
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; Mercedes Catalán; Cristina de la Calle; Rocío García-García; Carlos Gómez; Rocío Laguna-Goya; Manuel Lizasoáin; Joaquín Martínez-López; Julia Origüen; Ángel Sevillano; Eduardo Gutiérrez; Borja de Miguel; Fernando Aguilar; Patricia Parra; Mar Ripoll; Tamara Ruiz-Merlo; Hernando Trujillo; José Luis Pablos; Estela Paz-Artal; Carlos Lumbreras; José María Aguado
Source
International Journal of Infectious Diseases, Vol 117, Iss , Pp 56-64 (2022)
Subject
Language
English
ISSN
1201-9712
Abstract
Background: 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. Methods: 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. Results: 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). Conclusion: TCZ improves the prognosis of patients with COVID-19 the most if treatment starts within the first 48 hours after admission.