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HGNC Genes

SARS-CoV-2 proteins

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    Tocilizumab efficacy in COVID-19 MESHD patients is associated with respiratory severity-based stages

    Authors: Melchor Alvarez-Mon; Angel Asunsolo; Jose Sanz; Benjamin Munoz; Jose Alberto Arranz-Caso; Maria Novella Mena; Cristina Hernandez-Gutierrez; Jorge Navarro; Maria Cristina Lozano Duran; Juan Arevalo Serrano; Rocio Heche Sanchez; Lara Bravo Quiroga; Julio Flores Segovia; Marta Garcia Sanchez; Aida Gutierrez Garcia; Ana Perez; Marta Herrero; Nieves Plana; Daniel Troncoso; Gorjana Rackov; Carlos Martinez-A; Dimitrios Balomenos

    doi:10.1101/2021.03.04.21252167 Date: 2021-03-09 Source: medRxiv

    Background: Tocilizumab treatment is investigated, and effectiveness in ICU-admitted COVID-19 MESHD patients has been reported. Although controversy exists regarding the efficacy of tocilizumab treatment, it has been suggested that tocilizumab might show positive results depending on patient severity status. We examined an association between tocilizumab and distinct disease severity stages. Methods and Findings: From March 3 to March 23 2020, 494 consecutively admitted COVID-19 MESHD patients received tocilizumab or standard treatment alone. Data were obtained retrospectively. Clinical respiratory severity ( CRS MESHD) stages were defined by patient oxygenation status and were also associated to scores of WHO clinical progression scale. We categorized patients in three stages, mild/moderate CRS1 HGNC (FiSpO2<0.35; WHO score 5), moderate/severe CRS2 HGNC (FiO2=0.5/high flow mask; WHO score 6) and severe/critical CRS3 (FiO2<80%/high flow/prone position or mechanical ventilation; score>6). The primary outcome was the composite of death MESHD or ICU admission in patients of stages CRS1 HGNC, CRS2 HGNC, and CRS3, as well as in total patients. We also addressed mortality alone in total patients. Kaplan-Maier curves, Cox HGNC proportional regression and inverse probability weighting marginal structural models were used. We conducted the study from March 3 to April 7 2020 with broad-ranged severity patients; 167 tocilizumab-treated and 327 untreated. CRS1 HGNC patients showed no apparent benefit after treatment, while the risk of the primary outcome was greatly reduced in CRS2 HGNC treated participants ((HR=0.22; 95% CI (0.16-0.44)). Moreover, tocilizumab treatment was associated with significantly decreased CRS2 HGNC patient proportion that reached the outcome compared to non-treated controls (27.8.0% vs. 65.4%; p<0.001). Severe/critical CRS3 patients, also showed benefit after treatment (HR=0.38; 95% CI (0.16-90)), although not as robust as was that of CRS2 HGNC treated individuals. Tocilizumab was associated with reduced outcome risk in total patients (HR=0.42; 95% CI (0.26-0.66)) after CRS adjustment, but not if CRS classification was not accounted as confounding factor (HR=1.19; 95% CI (0.84-1.69)). The outcome of mortality alone upon tocilizumab treatment was significant (HR=0.58; 95% CI (0.35-0.96)) after accounting for CRS classification. Conclusions: Tocilizumab treatment is associated with reduced COVID-19 MESHD escalation in CRS2 HGNC patients, suggesting efficacy in moderate/severe non-ICU-admitted patients. CRS classification could represent an essential confounding factor in evaluating tocilizumab in studies of broad-ranged severity patients.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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