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Deprecated: Implicit conversion from float 300.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Int+J+Infect+Dis 2020 ; 99 (ä): 28-33 Nephropedia Template TP
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Early administration of interleukin-6 inhibitors for patients with severe COVID-19 disease is associated with decreased intubation, reduced mortality, and increased discharge #MMPMID32721528
Sinha P; Mostaghim A; Bielick CG; McLaughlin A; Hamer DH; Wetzler LM; Bhadelia N; Fagan MA; Linas BP; Assoumou SA; Ieong MH; Lin NH; Cooper ER; Brade KD; White LF; Barlam TF; Sagar M
Int J Infect Dis 2020[Oct]; 99 (ä): 28-33 PMID32721528show ga
OBJECTIVE: The aim of this observational study was to determine the optimal timing of interleukin-6 receptor inhibitor (IL6ri) administration for coronavirus disease 2019 (COVID-19). METHODS: Patients with COVID-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into two groups: those requiring =45% fraction of inspired oxygen (FiO(2)) (termed stage IIB) and those requiring >45% FiO(2) (termed stage III) at the time of IL6ri administration. The main outcomes were all-cause mortality, discharge alive from hospital, and extubation. RESULTS: A total of 255 COVID-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than those treated in stage III (adjusted hazard ratio (aHR) 0.24, 95% confidence interval (CI) 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR 1.43, 95% CI 1.06-1.93) and were less likely to be intubated (aHR 0.43, 95% CI 0.24-0.79). CONCLUSIONS: IL6ri administration prior to >45% FiO(2) requirement was associated with improved COVID-19 outcomes. This can guide clinical management pending results from randomized controlled trials.