“Ventilator-free days” composite outcome in patients with SARS-CoV-2 infection treated with tocilizumab: A retrospective competing risk analysis

• Published in: Heart & lung Vol. 56; pp. 118 - 124
• Main Authors: Mady, Ahmed F., Abdulrahman, Basheer, Mumtaz, Shahzad A., Al-Odat, Mohammed A., Kuhail, Ahmed, Altoraifi, Rehab, Alshae, Rayan, Alharthy, Abdulrahman M., Aletreby, Waleed Th
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022
• Subjects: COVID-19; COVID-19 Drug Treatment; Humans; Interleukin-6; Mechanical ventilation; Receptors, Interleukin-6; Respiration, Artificial; Retrospective Studies; Risk Assessment; SARS-CoV-2; Tocilizumab; Treatment Outcome; Ventilator-free days; FDA; IL; RNA; Tocilizumab; CI; TCZ; HR; IQR; Ventilator-free days; SOFA; SARS-CoV-2; HIV; VFD; RT-PCR; IRB; ICU; SHR; Mechanical ventilation; ARDS; aVFD; WHO; BMI
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2022.06.024

•Tocilizumab treatment in SARS-CoV-2 mechanically ventilated patients improves the composite outcome of 28-day mortality or continuity of ventilation.•It is associated with more actual ventilator free days.•There may be a mortality benefit with Tocilizumab treatment.•It is not associated with increased bacterial cultures. SARS-CoV-2 infection demonstrates a wide range of severity, with more severe cases presenting with a cytokine storm with elevated serum interleukin-6; hence, the interleukin-6 receptor antibody tocilizumab was used for the management of severe cases. To explore the effect of tocilizumab on ventilator-free day composite outcomes among critically ill patients with SARS-CoV-2 infection. This retrospective propensity score-matching study compared mechanically ventilated patients who received tocilizumab to a control group. Twenty-nine patients in the intervention group were compared to 29 controls. The matched groups were similar. The ventilator-free days composite outcome was higher in the intervention group (sub-distribution hazard ratio 2.7, 95% confidence interval [CI]: 1.2–6.3; p = 0.02), the mortality rate in the intensive care unit was not different (37.9% vs 62%, p = 0.1), and actual ventilator-free days were significantly longer in the tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio for death in the tocilizumab group (HR 0.49, 95% CI: 0.25–0.97; p = 0.04). Positive cultures were not significantly different among the groups (55.2% vs 34.5% in the tocilizumab and control groups, respectively; p = 0.1). Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated patients with SARS-CoV-2 infection. It is associated with significantly longer actual ventilator-free days, insignificantly lower mortality, and higher superinfection.