Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study
Abstract Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab...
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Nature Portfolio
2021
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oai:doaj.org-article:b632d86dac4740a59ca6312d3f6f933f2021-12-02T18:37:11ZTocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study10.1038/s41598-021-99291-z2045-2322https://doaj.org/article/b632d86dac4740a59ca6312d3f6f933f2021-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99291-zhttps://doaj.org/toc/2045-2322Abstract Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses (< 400 mg, 400–800 mg or > 800 mg), either at the viral (1–7 days post-symptom onset), early inflammatory (8–15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37–4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4–15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400–800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses.Alejandro Durán-MéndezAlma Delia Aguilar-ArroyoEmiliano Vivanco-GómezEduardo Nieto-OrtegaDaniela Pérez-OrtegaCristian Jiménez-PérezKarla Y. Hernández-SkewesGuillermo Montiel-BravoOscar J. Roque-ReyesFernanda Romero-LechugaDiana Medina-SantosPerla Oriana-RománJorge Rafael Flores-HernándezJuan Daniel Méndez-CocaDaniela Montaño-OlmosKarla Cecilia Farfán-LazosMiranda Tobón-CubillosAmérica Viveros-HernándezFernando Sevilla-CastilloÁngel Raúl Hernández-RomeroShannat Ortega-RodríguezAldo Christiaan Jardínez-VeraMaría Antonieta Solís-GonzálezAntonio Ramos de la MedinaLaura Martínez Pérez-MaldonadoElizabeth Lagunes-LaraMiguel Cova-BonillaAlberto N. PeónNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021) |
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Medicine R Science Q Alejandro Durán-Méndez Alma Delia Aguilar-Arroyo Emiliano Vivanco-Gómez Eduardo Nieto-Ortega Daniela Pérez-Ortega Cristian Jiménez-Pérez Karla Y. Hernández-Skewes Guillermo Montiel-Bravo Oscar J. Roque-Reyes Fernanda Romero-Lechuga Diana Medina-Santos Perla Oriana-Román Jorge Rafael Flores-Hernández Juan Daniel Méndez-Coca Daniela Montaño-Olmos Karla Cecilia Farfán-Lazos Miranda Tobón-Cubillos América Viveros-Hernández Fernando Sevilla-Castillo Ángel Raúl Hernández-Romero Shannat Ortega-Rodríguez Aldo Christiaan Jardínez-Vera María Antonieta Solís-González Antonio Ramos de la Medina Laura Martínez Pérez-Maldonado Elizabeth Lagunes-Lara Miguel Cova-Bonilla Alberto N. Peón Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| description |
Abstract Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses (< 400 mg, 400–800 mg or > 800 mg), either at the viral (1–7 days post-symptom onset), early inflammatory (8–15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37–4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4–15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400–800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses. |
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article |
| author |
Alejandro Durán-Méndez Alma Delia Aguilar-Arroyo Emiliano Vivanco-Gómez Eduardo Nieto-Ortega Daniela Pérez-Ortega Cristian Jiménez-Pérez Karla Y. Hernández-Skewes Guillermo Montiel-Bravo Oscar J. Roque-Reyes Fernanda Romero-Lechuga Diana Medina-Santos Perla Oriana-Román Jorge Rafael Flores-Hernández Juan Daniel Méndez-Coca Daniela Montaño-Olmos Karla Cecilia Farfán-Lazos Miranda Tobón-Cubillos América Viveros-Hernández Fernando Sevilla-Castillo Ángel Raúl Hernández-Romero Shannat Ortega-Rodríguez Aldo Christiaan Jardínez-Vera María Antonieta Solís-González Antonio Ramos de la Medina Laura Martínez Pérez-Maldonado Elizabeth Lagunes-Lara Miguel Cova-Bonilla Alberto N. Peón |
| author_facet |
Alejandro Durán-Méndez Alma Delia Aguilar-Arroyo Emiliano Vivanco-Gómez Eduardo Nieto-Ortega Daniela Pérez-Ortega Cristian Jiménez-Pérez Karla Y. Hernández-Skewes Guillermo Montiel-Bravo Oscar J. Roque-Reyes Fernanda Romero-Lechuga Diana Medina-Santos Perla Oriana-Román Jorge Rafael Flores-Hernández Juan Daniel Méndez-Coca Daniela Montaño-Olmos Karla Cecilia Farfán-Lazos Miranda Tobón-Cubillos América Viveros-Hernández Fernando Sevilla-Castillo Ángel Raúl Hernández-Romero Shannat Ortega-Rodríguez Aldo Christiaan Jardínez-Vera María Antonieta Solís-González Antonio Ramos de la Medina Laura Martínez Pérez-Maldonado Elizabeth Lagunes-Lara Miguel Cova-Bonilla Alberto N. Peón |
| author_sort |
Alejandro Durán-Méndez |
| title |
Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| title_short |
Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| title_full |
Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| title_fullStr |
Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| title_full_unstemmed |
Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| title_sort |
tocilizumab reduces covid-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study |
| publisher |
Nature Portfolio |
| publishDate |
2021 |
| url |
https://doaj.org/article/b632d86dac4740a59ca6312d3f6f933f |
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