Abstract
Background: This study aimed to evaluate the effectiveness of tocilizumab in mechanically ventilated patients with coronavirus disease 2019 (COVID-19).
Research design and methods: This retrospective multicenter study included adults (≥18 years) diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab, and requiring invasive mechanical ventilation during admission. Survival analyses with inverse propensity score treatment weighting (IPTW) and propensity score matching (PSM) were conducted. To account for immortal bias, we used Cox proportional modeling with time-dependent covariance. Competing risk analysis was performed for the extubation endpoint.
Results: A total of 556 (tocilizumab = 193, control = 363) patients were included. Males constituted the majority of the participants (69.2% in tocilizumab arm,74.1% in control arm). Tocilizumab was not associated with a reduction in mortality with hazard ratio [(HR) = 0.82,95% confidence interval (95%CI): 0.62-1.10] in the Inverse propensity score weighting (IPTW) analysis and (HR = 0.86,95% CI: 0.64-1.16) in the PSM analysis. However, tocilizumab was associated with an increased rate of extubation (33.6%) compared to the control arm (11.9%); subdistributional hazards (SHR) = 3.1, 95% CI: 1.86-5.16).
Conclusions: Although tocilizumab was not found to be effective in reducing mortality, extubation rate while on mechanical ventilation was higher among tocilizumab treated group.
Keywords: COVID-19; Tocilizumab; effectiveness; mechanical ventilation; mortality.
【저자키워드】 COVID-19, mechanical ventilation, Tocilizumab, mortality., Effectiveness, 【초록키워드】 Treatment, coronavirus disease, SARS-CoV-2, coronavirus, Mortality, risk, RT-PCR, Nasopharyngeal swab, Patient, Admission, PSM, Invasive mechanical ventilation, Research design, Analysis, propensity score matching, confidence interval, acute respiratory syndrome, Endpoint, control arm, hazard ratio, hazard, participant, reducing mortality, Retrospective multicenter study, reduction in mortality, Weighting, effective, inverse, polymerase chain, evaluate, diagnosed, conducted, was performed, treated, majority, analysis, mechanically ventilated patient, on mechanical ventilation, 【제목키워드】 multicenter, Evidence, COVID-19 patient, mechanically ventilated,