"Ventilator-free days" composite outcome in patients with SARS-CoV-2 infection treated with tocilizumab: A retrospective competing risk analysis.
Ahmed F Mady, Basheer Abdulrahman, Shahzad A Mumtaz and 6 others
PMID 35839546WHAT IT FOUND
In ventilated ICU patients with COVID-19, tocilizumab was associated with higher chance of being alive and off the ventilator by day 28.
Steroids and antivirals were also used in some, so its separate effect is unclear.
Key findings
01The main analysis found a higher chance of being alive and extubated by day 28 with tocilizumab, reported as a sub-distribution hazard ratio of 2.7 (95% CI 1.2-6.3; p=0.02).
02Actual ventilator-free days were higher with tocilizumab (median 10 days, IQR 0-13) than controls (median 0 days, IQR 0-2.25; p=0.02), while 28-day ICU mortality was not significantly lower (11 patients, 37.9% vs 18 patients, 62%; p=0.1).
03Tocilizumab patients also received steroids (17, 58.6%) and antivirals (11, 37.9%), and the study was retrospective, so the contribution of tocilizumab alone cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Retrospective design without randomisation; matching helps compare similar patients but cannot prove causation. Very small sample: only 29 tocilizumab patients and 29 matched controls, so the study is underpowered and non-significant mortality or culture findings may be due to size. Tocilizumab was given alongside usual ICU care, antivirals and steroids, so the separate effect of tocilizumab cannot be isolated. Some patients may have been included in a previous publication, and the number is uncertain. The study did not capture timing details such as duration of symptoms before hospitalisation, duration of mechanical ventilation, or timing of tocilizumab, and did not distinguish positive cultures from true infection requiring treatment. Propensity matching was not performed by the classical logistic-regression method and used 1:1 matching, which the authors note could have been better.
Declared interests
The authors declared nothing to declare.
The easy way to misread this
Do not conclude that tocilizumab alone improves survival or ventilator outcomes. The study was retrospective, had only 29 patients in each group, and patients also received steroids, antivirals and mechanical ventilation, so the effect of tocilizumab cannot be separated from other care.