Tocilizumab timing and COVID-19 mortality: a cohort study of early vs late administration
Abstract Background The optimal timing of tocilizumab treatment during the disease course of COVID 19 has yet to be adequately defined in the context of randomised controlled trials, and the effect of tocilizumab on real-world populations remains unclear. We examined the effect of different timing of tocilizumab, on mortality, in a cohort of adults with COVID 19. Methods All adults (≥ 18 years old) with confirmed COVID-19 admitted to four hospitals in the West of Scotland between 8th Jan 2021 and 31st March 2021 and who received tocilizumab were included in a retrospective cohort study. Patients were assigned to either an early (day 0 or day 1 of admission) or late (days 2 to 7 of admission) cohort based on tocilizumab initiation. The primary outcome was 90 day all-cause mortality, in early versus late cohorts. Secondary outcomes were 28 and 180 day all-cause mortality. Results 203 patients were included (138 in the early cohort and 65 in the late cohort). Mortality was significantly higher in the late cohort compared to the early cohort (adjusted OR: 3.33; CI: 1.29 to 8.54; p = 0.012). The secondary outcomes demonstrated the same effect with higher rates of death at 28 days (late cohort adjusted OR: 3.28; CI 1.23 to 8.75; p = 0.018) and 180 days (late cohort adjusted OR: 3.70; CI 1.45–9.45; p = 0.006). This effect was seen whether the outcome was adjusted or unadjusted. Mortality at 90 days in the early cohort was 22% (n = 30) compared to 45% (n = 29) in the late cohort (P = < 0.001). Conclusion Early administration of tocilizumab within the first 2 days of hospitalisation was associated with significant survival benefit compared to late exposure. Late administration was associated with particularly high mortality..
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Preprint| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
ResearchSquare.com - (2023) vom: 28. Nov. Zur Gesamtaufnahme - year:2023 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
MacGregor, Fiona [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-3636426/v1 |
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| PPN (Katalog-ID): |
XRA041687477 |
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| 520 | |a Abstract Background The optimal timing of tocilizumab treatment during the disease course of COVID 19 has yet to be adequately defined in the context of randomised controlled trials, and the effect of tocilizumab on real-world populations remains unclear. We examined the effect of different timing of tocilizumab, on mortality, in a cohort of adults with COVID 19. Methods All adults (≥ 18 years old) with confirmed COVID-19 admitted to four hospitals in the West of Scotland between 8th Jan 2021 and 31st March 2021 and who received tocilizumab were included in a retrospective cohort study. Patients were assigned to either an early (day 0 or day 1 of admission) or late (days 2 to 7 of admission) cohort based on tocilizumab initiation. The primary outcome was 90 day all-cause mortality, in early versus late cohorts. Secondary outcomes were 28 and 180 day all-cause mortality. Results 203 patients were included (138 in the early cohort and 65 in the late cohort). Mortality was significantly higher in the late cohort compared to the early cohort (adjusted OR: 3.33; CI: 1.29 to 8.54; p = 0.012). The secondary outcomes demonstrated the same effect with higher rates of death at 28 days (late cohort adjusted OR: 3.28; CI 1.23 to 8.75; p = 0.018) and 180 days (late cohort adjusted OR: 3.70; CI 1.45–9.45; p = 0.006). This effect was seen whether the outcome was adjusted or unadjusted. Mortality at 90 days in the early cohort was 22% (n = 30) compared to 45% (n = 29) in the late cohort (P = < 0.001). Conclusion Early administration of tocilizumab within the first 2 days of hospitalisation was associated with significant survival benefit compared to late exposure. Late administration was associated with particularly high mortality. | ||
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| 700 | 1 | |a Caulfield, Carolyn |4 aut | |
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