Effect of Tocilizumab Towards Clinical Outcomes and Safety Among Critically-ill Coronavirus Disease 2019 (Covid-19) Patients: A Retrospective Cohort Study
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Abstract
Introduction: Tocilizumab is hypothesized to lessen Covid-19 disease severity. Global research on its clinical application and safety yielded mixed results. This prompted a need to verify previous findings locally. Our study aimed to compare the effect on clinical outcomes and safety of Tocilizumab-treatment (TOC) versus Standard-of-Care (SOC) in critically-ill Covid-19 patients. Materials and methods: A retrospective cohort study was conducted among critically-ill Covid-19 patients admitted to a Malaysian secondary care hospital between April 2020 to June 2021. Patients were randomly sampled into TOC or SOC cohort using a 1:6 ratio propensity score (PS) matching. Information on patients' demographic and clinical parameters were retrospectively reviewed from medical records. Study endpoints were clinical outcomes (all-cause in-hospital mortality, 6-point ordinal scale clinical improvement, organ support free and inflammatory markers improvement). Complications developed post-study inclusion were monitored as safety evaluation. Results: A total of 182 patients was included with 26 TOC-patients and 156 SOC-patients. Our study demonstrated insignificance in mortality, clinical improvement and organ support free after Tocilizumab administration (p>0.05). Of interest, Tocilizumab did show protective effect by reducing inflammatory marker, specifically C-reactive protein (CRP) [AOR 3.727 (95% CI: 1.061 to 13.090; p=0.040)]. The frequency of complications developed was balanced between TOC versus SOC (p>0.05). Conclusion: Tocilizumab treatment in critically-ill Covid-19 did not favour overall clinical outcomes despite effective CRP reduction. Nevertheless, it provided comparable safety profiles as control. Considering its high-acquisition cost, this study provided insights to guide future clinical justification for its prudent use in Covid-19, particularly when transitioning into the post-pandemic era.
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