Identification of Clinical Response Predictors of Tocilizumab Treatment in Patients with Severe COVID-19 Based on Single-Center Experience

Hyperinflammation in COVID-19 plays a crucial role in pathogenesis and severity; thus, many immunomodulatory agents are applied in its treatment. We aimed to identify good clinical response predictors of tocilizumab (TCZ) treatment in severe COVID-19, among clinical, laboratory, and radiological var...

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Bibliographic Details
Published in:Journal of clinical medicine 2023-03, Vol.12 (6), p.2429
Main Authors: Schmidt, Wiktor, Pawlak-Buś, Katarzyna, Jóźwiak, Barbara, Leszczyński, Piotr
Format: Article
Language:English
Subjects:
Autopsies
Bacterial infections
Blood diseases
Blood pressure
Clinical medicine
Clinical trials
Coronaviruses
COVID-19
Cytokine storm
Drug dosages
Emergency medical care
FDA approval
Hospitals
Infections
Laboratories
Mortality
Observational studies
Pandemics
Patients
Pneumonia
Pulse oximetry
Respiratory diseases
Respiratory failure
Sepsis
Severe acute respiratory syndrome coronavirus 2
Tomography
Viral infections
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Summary:Hyperinflammation in COVID-19 plays a crucial role in pathogenesis and severity; thus, many immunomodulatory agents are applied in its treatment. We aimed to identify good clinical response predictors of tocilizumab (TCZ) treatment in severe COVID-19, among clinical, laboratory, and radiological variables. We conducted a prospective, observational study with 120 patients with severe COVID-19 not improving despite dexamethasone (DEX) treatment. We used parametric and non-parametric statistics, univariate logistic regression, receiver operating characteristic (ROC) curves, and nonlinear factors tertile analysis. In total, 86 (71.7%) patients achieved the primary outcome of a good clinical response to TCZ. We identified forty-nine predictive factors with potential utility in patient selection and treatment monitoring. The strongest included time from symptom onset between 9 and 12 days, less than 70% of estimated radiological lung involvement, and lower activity of lactate dehydrogenase. Additional predictors were associated with respiratory function, vitamin D concentration, comorbidities, and inflammatory/organ damage biomarkers. Adverse events analysis proved the safety of such a regimen. Our study confirmed that using TCZ early in the hyperinflammatory phase, before severe respiratory failure development, is most beneficial. Considering the described predictive factors, employing simple and widely available laboratory, radiological, and clinical tools can optimize patient selection for immunomodulatory treatment with TCZ.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12062429