Early Tocilizumab Dosing Is Associated With Improved Survival in Critically Ill Patients Infected With Severe Acute Respiratory Syndrome Coronavirus-2
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Abstract
To identify the most efficacious timing for tocilizumab administration in critically ill patients infected with severe acute respiratory syndrome coronavirus-2.
Design:
Observational multicenter cohort study.
Setting:
A total of 23 acute care hospitals in four states.
Patients:
One-hundred eighteen patients admitted between March 13, 2020, and April 16, 2020. Eighty-one patients received tocilizumab, and 37 were untreated and served as a control group.
Measurements and Main Results:
The main outcome was mortality and was analyzed by timing of tocilizumab dosing. Early dosing was defined as a tocilizumab dose administered prior to or within 1 day of intubation. Late dosing was defined as a dose administered greater than 1 day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was used for comparison. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated ( p = 0.003). Dosing tocilizumab late was associated with an increased mortality compared with the untreated group ( p = 0.006).
Conclusions:
Early tocilizumab administration was associated with decreased mortality in critically ill severe acute respiratory syndrome coronavirus-2 patients, but a potential detriment was suggested by dosing later in a patient’s course.
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SciScore for 10.1101/2020.10.27.20211433: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has certain limitations. This study was observational and we did not formally evaluate patients for hepatitis B or latent tuberculosis. Although no baseline characteristics were statistically significant between our …
SciScore for 10.1101/2020.10.27.20211433: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has certain limitations. This study was observational and we did not formally evaluate patients for hepatitis B or latent tuberculosis. Although no baseline characteristics were statistically significant between our groups, patients who received tocilizumab were also treated with antibiotics, anticoagulants, and steroid therapy in varying combinations. Accordingly, it is difficult to identify the most clinically influential modality or optimal therapeutic combination. To date, no prospective randomized studies analyzing the combination of all potential COVID treatment modalities within a specific therapeutic window have been published. Pending the availability of this data, our study provides guidance to clinicians striving to identify the most efficacious timing for tocilizumab therapy. The presented data supports a mortality benefit of early tocilizumab therapy, within 1 day of intubation, and a possible detriment to later dosing. We strongly encourage the use of tocilizumab earlier in the COVID-19 treatment spectrum.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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