使用托西珠单抗治疗 COVID-19 重症感染的长期功能预后：多中心前瞻性观察研究：COVID-19康复研究II中的机械通气ICU患者

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-04-17 DOI:10.1016/j.jiac.2025.102708

Junji Hatakeyama , Kensuke Nakamura , Naoki Kanda , Akira Kawauchi , Shigeki Fujitani , Taku Oshima , Hideaki Kato , Kohei Ota , Hiroshi Kamijo , Tomohiro Asahi , Yoko Muto , Miyuki Hori , Arisa Iba , Mariko Hosozawa , Hiroyasu Iso

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引用次数: 0

摘要

背景：tocilizumab是一种IL-6受体拮抗剂，可能通过减弱细胞因子风暴来预防危重患者的功能损伤。本研究探讨了托珠单抗对预防2019年严重冠状病毒感染（COVID-19）患者功能损伤的潜在影响。方法在一项多中心前瞻性观察研究中，对2021年4月至2021年9月入住重症监护病房并存活出院的COVID-19≥20岁需要机械通气的患者进行为期1年的随访。于2022年8月邮寄了一份关于后遗症和功能障碍的自我管理问卷，并收集了数据。采用多变量logistic回归评估tocilizumab对身体功能、心理健康和长冠状病毒的影响。结果157例患者中，41例接受了托珠单抗治疗。托珠单抗组有更严重的疾病，但与非托珠单抗组相比，身体损伤（17.1% vs. 23.3%, p = 0.41）和精神障碍（19.5% vs. 39.7%, p = 0.009）的患病率较低。托珠单抗组的Long COVID患病率较高（92.7% vs. 80.2%, p = 0.06），而疲劳/不适明显较低（19.5% vs. 37.1%, p = 0.039）。tocilizumab对身体损害、精神障碍和长COVID的校正优势比（95%置信区间）分别为0.70（0.2-2.1）、0.40（0.16-1.01）和2.94(0.7-12.3)，差异无统计学意义。结论：sicilizumab与重症COVID-19患者1年内较低的身体损伤和精神障碍患病率相关。此外，长冠肺炎对身体和认知功能的影响较弱。

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Long-term functional prognosis with tocilizumab in severe COVID-19 infection: A multicenter prospective observational study on mechanically ventilated ICU patients in the COVID-19 recovery study II

Background

Tocilizumab, an IL-6 receptor antagonist, may prevent functional impairments in critically ill patients by attenuating the cytokine storm. This study investigated a potential effect of tocilizumab on preventing functional impairments in patients with severe coronavirus infection 2019 (COVID-19).

Methods

In a multicenter prospective observational study, patients with COVID-19 ≥ 20 years requiring mechanical ventilation admitted to the intensive care unit between April 2021 and September 2021 and discharged alive were followed for one year. A self-administered questionnaire on sequelae and functional impairments was mailed in August 2022, and data were collected. A multivariate logistic regression was used to assess the impact of tocilizumab on physical function, mental health, and Long COVID.

Results

Of 157 analyzed patients, 41 received tocilizumab. The tocilizumab group had more severe illness, but a lower prevalence of physical impairment (17.1 % vs. 23.3 %, p = 0.41) and mental disorders (19.5 % vs. 39.7 %, p = 0.009) than the non-tocilizumab group. The prevalence of Long COVID was higher in the tocilizumab group (92.7 % vs. 80.2 %, p = 0.06), whereas fatigue/malaise was significantly lower (19.5 % vs. 37.1 %, p = 0.039). Adjusted odds ratios (95 % confidence interval) for physical impairment, mental disorders, and Long COVID with tocilizumab were 0.70 (0.2–2.1), 0.40 (0.16–1.01), and 2.94 (0.7–12.3), respectively, with no significant difference.

Conclusions

Tocilizumab was associated with a lower prevalence of physical impairment and mental disorders at 1 year in patients with severe COVID-19. Furthermore, Long COVID had a weaker impact on physical and cognitive functions.

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.