Bradley Troyer, PharmD,
PGY2 Critical Care Pharmacy Resident
West Virginia University Medicine J.W. Ruby Memorial Hospital
Morgantown, West Virginia
Disclosure information not submitted.
Nicole Kovacic Scherrer, BCCCP, PharmD
West Virginia University Hospital
Morgantown, West Virginia
Disclosure information not submitted.
Jeffery Garavaglia, PharmD, BCCCP
Clinical Pharmacy Specialist, Neurocritical Care
West Virginia University Medicine, United States
Disclosure information not submitted.
Title: Effect of Tocilizumab on Outcomes of COVID Patients with Obesity
INTRODUCTION/HYPOTHESIS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of patients worldwide since its emergence in 2019. Interleukin-6 receptors antagonists, such as tocilizumab, have emerged as potential treatments for the severe systemic effects of the virus. In the RECOVERY trial, the tocilizumab group had a lower mortality compared to the standard of care (29% vs. 33%, p=0.007). However, there is a lack of data regarding the use of tocilizumab in high-risk groups, such as patients with obesity. The RECOVERY trial included no information on body mass index (BMI), making it difficult to assess tocilizumab’s efficacy in that subgroup. This study was designed to determine if tocilizumab has the same benefit in patients with an elevated BMI.
Methods: This was a multi-center retrospective analysis comparing outcomes of obese patients who received the standard of care plus tocilizumab to patients who only received the standard of care for SARS-CoV-2. Included patients had a BMI>30, required intensive care unit (ICU) level care, and positive pressure ventilation (high-flow nasal canula, continuous or bilevel positive airway pressure, mechanical ventilation).
Results: At baseline, the median BMI was similar between the groups, but the tocilizumab group was younger (56 vs. 68 years old, p< 0.001) and had lower rates of chronic kidney disease (2.8% vs. 13.7%, p=0.019), hyperlipidemia (37.1% vs. 58.9%, p=0.009), and coronary artery disease (10.0% vs. 24.6%, p=0.021). Patients had similar days of any positive pressure ventilatory support (10 vs. 9 days, p=0.101) and days of specifically mechanical ventilation (4 vs. 3 days, p=0.453). Patients who received tocilizumab had longer stays in the ICU (10.5 vs. 8 days, p=0.039) but lower in-hospital mortality rates (27.1% vs. 46.5%, p=0.016). There was no difference in number of new positive blood cultures or invasive fungal infections post-initiation of ventilatory support.
Conclusion: Despite an elevated BMI, the associated mortality rate of patients who received tocilizumab in this study was similar to the mortality rate of the tocilizumab group in the RECOVERY trial. Patients who received only the standard of care had an associated higher rate of mortality, but were also older with more co-morbidities, potentially impacting the results.