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Rutgers A, Westerweel PE, van der Holt B, Postma S, van Vonderen MGA, Piersma DP, Postma D, van den Berge M, Jong E, de Vries M, van der Burg L, Huugen D, van der Poel M, Kampschreur LM, Nijland M, Strijbos JH, Tamminga M, Mutsaers PGNJ, Schol-Gelok S, Dijkstra-Tiekstra M, Sidorenkov G, Vincenten J, van Geffen WH, Knoester M, Kosterink J, Gans R, Stegeman C, Huls G, van Meerten T. Timely administration of tocilizumab improves outcome of hospitalized COVID-19 patients. PLoS One 2022; 17:e0271807. [PMID: 35960720 PMCID: PMC9374226 DOI: 10.1371/journal.pone.0271807] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/25/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study was to determine the efficacy of early tocilizumab treatment for hospitalized patients with COVID-19 disease. Methods Open-label randomized phase II clinical trial investigating tocilizumab in patients with proven COVID-19 admitted to the general ward and in need of supplemental oxygen. The primary endpoint of the study was 30-day mortality with a prespecified 2-sided significance level of α = 0.10. A post-hoc analysis was performed for a combined endpoint of mechanical ventilation or death at 30 days. Secondary objectives included comparing the duration of hospital stay, ICU admittance and duration of ICU stay and the duration of mechanical ventilation. Results A total of 354 patients (67% men; median age 66 years) were enrolled of whom 88% received dexamethasone. Thirty-day mortality was 19% (95% CI 14%-26%) in the standard arm versus 12% (95% CI: 8%-18%) in the tocilizumab arm, hazard ratio (HR) = 0.62 (90% CI 0.39–0.98; p = 0.086). 17% of patients were admitted to the ICU in each arm (p = 0.89). The median stay in the ICU was 14 days (IQR 9–28) in the standard arm versus 9 days (IQR 5–14) in the tocilizumab arm (p = 0.014). Mechanical ventilation or death at thirty days was 31% (95% CI 24%-38%) in the standard arm versus 21% (95% CI 16%-28%) in the tocilizumab arm, HR = 0.65 (95% CI 0.42–0.98; p = 0.042). Conclusions This randomized phase II study supports efficacy for tocilizumab when given early in the disease course in hospitalized patients who need oxygen support, especially when concomitantly treated with dexamethasone. Trial registration https://www.trialregister.nl/trial/8504.
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Affiliation(s)
- Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Peter E. Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Simone Postma
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Djura P. Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Douwe Postma
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eefje Jong
- Department of Infectious Diseases, Meander MC, Amersfoort, The Netherlands
| | - Marten de Vries
- Department of Pulmonology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Leonie van der Burg
- Department of Internal Medicine, Antonius Hospital Sneek, Sneek, The Netherlands
| | - Dennis Huugen
- Department of Internal Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Marjolein van der Poel
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Linda M. Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marcel Nijland
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jaap H. Strijbos
- Department of Pulmonology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Menno Tamminga
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Suzanne Schol-Gelok
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Emergency Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Julien Vincenten
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Wouter H. van Geffen
- Department of Pulmonology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marjolein Knoester
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jos Kosterink
- Pharmacy, University Medical Center Groningen, Groningen, The Netherlands
| | - Reinold Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Coen Stegeman
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerwin Huls
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom van Meerten
- Department of Haematology, University Medical Center Groningen, Groningen, The Netherlands
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