ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Tocilizumab Has Limited Clinical Utility for COVID19 in Two Multiethnic Community Hospitals
Session Title
TP92 - TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19
Abstract
A3858 - Tocilizumab Has Limited Clinical Utility for COVID19 in Two Multiethnic Community Hospitals
Author Block: K. Cervellione1, G. Dadi2, N. Hameedi2, M. Pignanelli2, B. Kuriakose2, V. Zafonte3, T. Ullah1, J. Robitsek3, G. Pena Fatule3, H. Patel3, D. M. Wisa2, K. Gafoor3, M. Walczyszyn2, J. Shakil2, F. Bagheri3, A. Solinas2, R. Mendelson3; 1MediSys Health Network, Jamaica, NY, United States, 2Flushing Hospital, Flushing, NY, United States, 3Jamaica Hospital, Jamaica, NY, United States.
The COVID19 pandemic has pushed healthcare workers to utilize available therapeutics, often with limited evidence. Theoretically, IL6 inhibitors could help to stop or reverse the damage caused by COVID19 cytokine storm. Published evidence from the United States is conflicting and is largely from academic institutions and non-minority populations. This study assessed the clinical utility of open-label tocilizumab in two multiethnic community hospitals in Queens, NY.Tocilizumab (8mg/kg) was given to 114 patients for treatment of COVID19-related respiratory failure between April 4 and May 19 2020 (96% received 1 dose). A retrospective cohort study was performed to determine 28-day clinical success, defined as achieving a score of 1 using a 6-point scale (1=no O2 requirement or discharged home on 2L/min; 2=low-flow O2 in hospital ≤6L/min; 3=O2 >6 to ≤15L/min; 4=high-flow, CPAP, or BiPAP; 5=mechanically ventilated (MV); 6=expired). The decision to administer tocilizumab was made by a committee based on unstable or worsening respiratory status. Mean patient age was 60 years (SD=11); 77(67%) were male. 25% were Asian, 23% black (31% black Hispanic), 36% white (73% white Hispanic), and 14% other. A majority of patients had at least 1 significant comorbidity, including HTN 56%, DM 40%, HLD 43%, and COPD/asthma 16%. Median days of symptoms at dose was 14(IQR 10-19); SpO2 on RA at admission was 82%(IQR 67-88%). Baseline status by ordinal scale was as follows: 2= 9(8%); 3=33(29%); 4=38(33%); 5=34(30%) (IQR 1-2 days on vent). Median CRP=19.9, d-dimer=1658, ferritin=593, and LDH=1561. 28-day success was achieved in 35(31%) patients; 62(55%) patients expired or were MV on day 28. Of patients who were on high-flow, CPAP, BiPAP or MV at baseline, 80% expired or were on MV on day 28. Estimated mortality in all hospitalized patients during the time frame at these hospitals was 36%. No significant differences were seen in labs, comorbidities or age between patients who did and did not have clinical success. Higher baseline ordinal scale score was predictive of mortality.Tocilizumab provided little to no clinical utility, especially in those with high oxygenation needs at time of dosing (success rate <20%). The main limitation is lack of a control group; however mortality was strikingly high. This in part may be due to the demographic and clinical characteristics of our sample.
Author Block: K. Cervellione1, G. Dadi2, N. Hameedi2, M. Pignanelli2, B. Kuriakose2, V. Zafonte3, T. Ullah1, J. Robitsek3, G. Pena Fatule3, H. Patel3, D. M. Wisa2, K. Gafoor3, M. Walczyszyn2, J. Shakil2, F. Bagheri3, A. Solinas2, R. Mendelson3; 1MediSys Health Network, Jamaica, NY, United States, 2Flushing Hospital, Flushing, NY, United States, 3Jamaica Hospital, Jamaica, NY, United States.
The COVID19 pandemic has pushed healthcare workers to utilize available therapeutics, often with limited evidence. Theoretically, IL6 inhibitors could help to stop or reverse the damage caused by COVID19 cytokine storm. Published evidence from the United States is conflicting and is largely from academic institutions and non-minority populations. This study assessed the clinical utility of open-label tocilizumab in two multiethnic community hospitals in Queens, NY.Tocilizumab (8mg/kg) was given to 114 patients for treatment of COVID19-related respiratory failure between April 4 and May 19 2020 (96% received 1 dose). A retrospective cohort study was performed to determine 28-day clinical success, defined as achieving a score of 1 using a 6-point scale (1=no O2 requirement or discharged home on 2L/min; 2=low-flow O2 in hospital ≤6L/min; 3=O2 >6 to ≤15L/min; 4=high-flow, CPAP, or BiPAP; 5=mechanically ventilated (MV); 6=expired). The decision to administer tocilizumab was made by a committee based on unstable or worsening respiratory status. Mean patient age was 60 years (SD=11); 77(67%) were male. 25% were Asian, 23% black (31% black Hispanic), 36% white (73% white Hispanic), and 14% other. A majority of patients had at least 1 significant comorbidity, including HTN 56%, DM 40%, HLD 43%, and COPD/asthma 16%. Median days of symptoms at dose was 14(IQR 10-19); SpO2 on RA at admission was 82%(IQR 67-88%). Baseline status by ordinal scale was as follows: 2= 9(8%); 3=33(29%); 4=38(33%); 5=34(30%) (IQR 1-2 days on vent). Median CRP=19.9, d-dimer=1658, ferritin=593, and LDH=1561. 28-day success was achieved in 35(31%) patients; 62(55%) patients expired or were MV on day 28. Of patients who were on high-flow, CPAP, BiPAP or MV at baseline, 80% expired or were on MV on day 28. Estimated mortality in all hospitalized patients during the time frame at these hospitals was 36%. No significant differences were seen in labs, comorbidities or age between patients who did and did not have clinical success. Higher baseline ordinal scale score was predictive of mortality.Tocilizumab provided little to no clinical utility, especially in those with high oxygenation needs at time of dosing (success rate <20%). The main limitation is lack of a control group; however mortality was strikingly high. This in part may be due to the demographic and clinical characteristics of our sample.
