Journal Article

Does timing of tocilizumab administration affect mortality in COVID-19? A Scottish multicentre retrospective cohort study

MacGregor, Fiona, Henderson, Philip, Lowrie, Richard, Caulfield, Carolyn, MacTavish, Pamela, Oprey, Alison

2024

Overview

BackgroundThe 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.MethodsAll adults (≥18 years old) with confirmed COVID-19 admitted to four hospitals in the West of Scotland between 8 January 2021 and 31 March 2021 and who received tocilizumab were included in a retrospective observational cohort study. Patients were assigned to either an early (day of admission or first day after admission) or late (days 2–7 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.Results203 patients were included in the analysis (138 in the early cohort, 65 in the late cohort). Mortality in 90 days in the early cohort was 22% (n=30) compared with 45% (n=29) in the late cohort (p<0.001). The adjusted mortality was significantly higher in the late cohort compared with the early cohort (adjusted OR: 3.33; 95% CI: 1.29 to 8.54; p=0.012). The secondary outcomes demonstrated the same effect with higher rates of death in 28 days (late cohort adjusted OR: 3.28; 95% CI: 1.23 to 8.75; p=0.018) and 180 days (late cohort adjusted OR: 3.70; 95% CI: 1.45 to 9.45; p=0.006). The effect was seen whether the outcome was adjusted or unadjusted.ConclusionEarly administration of tocilizumab within the first 2 days of hospitalisation was associated with a significant survival benefit compared with late exposure. Late administration was associated with particularly high mortality. The observed association may be a result of residual confounders and further research is needed.

• Publisher: British Thoracic Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Aged / Aged, 80 and over / Antibodies, Monoclonal, Humanized - administration & dosage / Antibodies, Monoclonal, Humanized - therapeutic use / Clinical trials / Cohort analysis / COVID-19 / COVID-19 - mortality / COVID-19 Drug Treatment / Critical Care / Cytokines / Data collection / Drug Administration Schedule / Drug dosages / Female / Hospitals / Humans / Intensive care / Male / Middle Aged / Monoclonal antibodies / Mortality / Original Research / Patients / Pneumonia / Respiratory Infection / Retrospective Studies / SARS-CoV-2 / Scotland - epidemiology / Steroids / Time Factors / Treatment Outcome / Ventilators / Viral infection