Evidence map›Paper›PMID 32651997›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021

Tocilizumab for Treatment of Mechanically Ventilated Patients With COVID-19.

Emily C Somers, Gregory A Eschenauer, Jonathan P Troost, Jonathan L Golob, Tejal N Gandhi, Lu Wang, Nina Zhou, Lindsay A Petty, Ji Hoon Baang, Nicholas O Dillman and 12 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 290 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
290citing papers in PubMed, 19 pooled it
11.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

290 citing papers in PubMed, 19 syntheses or guidelines pooled it, 498 citations in OpenAlex.

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  14. Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021
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  17. Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2021
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  19. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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  20. Trial

230 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors at 2 institutions in 1 country.

Emily C SomersDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.ORCID 0000-0001-5234-3978
Gregory A EschenauerDepartment of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Jonathan P TroostMichigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, Michigan, USA.
Jonathan L GolobDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Tejal N GandhiDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Lu WangDepartment of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
Nina ZhouDepartment of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
Lindsay A PettyDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Ji Hoon BaangDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Nicholas O DillmanDepartment of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
David FrameDepartment of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Kevin S GreggDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Dan R KaulDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Jerod NagelDepartment of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Twisha S PatelDepartment of Pharmacy, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Shiwei ZhouDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Adam S LauringDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
David A HanauerDepartment of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.
Emily MartinDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Pratima SharmaDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Christopher M FungDepartment of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Jason M PogueDepartment of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
University of Michigan · USMichigan Medicine · US

Funding

Michigan Institute for Clinical and Health Research (MICHR)UL1TR002240 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI LUMENG, JULIE C, MASHOUR, GEORGE ALEXANDER · 2017 to 2022
$54.9M
K12: Career Development in Emergency Critical Care ResearchK12HL133304 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI NEUMAR, ROBERT W., PINSKY, DAVID J. · 2016 to 2020
$2.2M
ACL HHS U01IP000974American Society for Transplantation and Cellular Therapy New Investigator AwardCDC HHS U01IP000974NCATS NIH HHS UL1 TR002240NCIRD CDC HHS U01 IP000974NHLBI NIH HHS K12 HL133304NIH HHS UL1TR002240
6 · The paper itself

Abstract

backgroundSevere coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment.

methodsWe assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared with tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability of treatment weighting (IPTW).

results154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range, 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean: 55 vs 60 years), less likely to have chronic pulmonary disease (10% vs 28%), and had lower D-dimer values at time of intubation (median: 2.4 vs 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death (HR, .55; 95% CI, .33-.90) and improved status on the ordinal outcome scale [OR per 1-level increase, .58; .36-.94). Although tocilizumab was associated with an increased proportion of patients with superinfections (54% vs 26%; P < .001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection (22% vs 15%; P = .42). Staphylococcus aureus accounted for ~50% of bacterial pneumonia.

conclusionsIn this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence.

Indexed as

COVID-19 Drug TreatmentRespiration, ArtificialAntibodies, Monoclonal, HumanizedHumansSARS-CoV-2Treatment OutcomeAntibodies, Monoclonal, HumanizedtocilizumabCOVID-19interleukin-6SARS-CoV-2tocilizumab

Identifiers

PMID32651997
PMCPMC7454462
OpenAlexW3041464116

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.