Tocilizumab effectiveness in mechanically ventilated COVID-19 patients (T-MVC-19 Study): a multicenter real-world evidence

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 (MeSH):

• Tocilizumab
• mechanical ventilation
• COVID-19
• mortality
• effectiveness

Acknowledgements

The authors would like to thank the staff at Ministry of Health hospitals. This publication was supported by the Deanship of Scientific Research at Prince Sattam bin Abdulaziz University, King Faisal Specialist Hospital and Research Center and Deanship of Scientific Research at King Faisal University.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors Contributions

Conceptualization was by Y.A.M; A.A (Ahmad Alamer); A.A.A (Ahmed A Alrashed); A.S.A. Statistics, methodology, software and interpretation of the results was done by A.A (Ahmad Alamer). Consultation on statistics was provided by I.A. The first draft of the paper was done by A.A, Y.A.M., and D.A. Abstract was drafted by N.A and.. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, declare their responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Supplementary material

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Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.