Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia
- Type de publi. : Article dans une revue
- Date de publi. : 01/01/2021
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Auteurs :
Olivier HermineXavier MariettePierre-Louis TharauxMatthieu Resche-RigonRaphaël PorcherPhilippe H. RavaudSerge BureauMaxime DougadosAnnick TibiÉlie AzoulayJacques CadranelJoseph EmmerichMuriel FartoukhBertrand GuidetGiovanna MarazziKarine LacombeMatthieu MahevasFrédéric PeneValérie Pourchet-MartinezFrédéric SchlemmerYazdan YazdanpanahGabriel BaronElodie PerrodeauDamien VanhoyeCécile KedziaLauren DemervilleAnne Gysembergh-HoualAlexandre BourgoinSarah DalibeyNabil RakedLakhdar MameriStéphanie AlarySamir HamiriaThinhinane BarizHala SemriDhiaa Meriem HaiMoustafa BenaflaMohamed BelloulPernelle VauboinSaskia FlamandClaire PachecoAnouk Walter-PetrichEmilia StanSouad BenarabCorine NyanouClaire MontlahucLucie BiardRobin CharreteurCeline DupréKévin CardetBlandine LehmannKamyl BaghliClaire MadeleineEric d'OrtenzioOriane PuéchalCaroline SemailleLaurent SavaleAnatole HarroisSamy FigueiredoJacques DuranteauNadia AnguelXavier MonnetChristian RichardJean-Louis TeboulP. DurandPierre TissieresMitja JevnikarDavid MontaniStéphan PavyNicolas NoelOlivier LambotteLelia EscautStéphane JauréguiberryElodie BaudryChristiane VernyEdouard LefèvreMohamad ZaidanClotilde Le Tiec Le TiecCéline Verstuyft VerstuyftAnne-Marie RoquesLamiae GrimaldiDomitille MolinariGaël LeprunAlain FourreauLaurent CyllyMyriam VirlouvetRamdane MeftaliSolène FabreMarion LicoisAsmaa MamouneYacine BoudaliSophie Georgin-LaviallePatricia SenetA. SoriaAntoine ParrotHélène FrançoisNathalie RozensztajnEmmanuelle BlinPascaline ChoinierJuliette CamusetJean-Simon RechAntony CanellasCamille Rolland-DebordNadège LemariéNicolas BelaubeMarine NadalMartin SiguierCamille Petit-HoangJulie ChasElodie DrouetMatthieu LemoineAudrey PhibelLucie AunayEliane BertrandSylviane RavatoMarie VayssettesAnne AddaCeline WilpottePélagie ThibautJulie FillonIsabelle DebrixSoraya FellahiJean-Philippe BastardGuillaume LefèvreVincent FalletJacques-Eric GottenbergYves HansmannEmmanuel AndrèsSophie BayerGuillaume BeckerFrédéric BlancStéphane BrinVincent CastelainEmmanuel ChatelusEva ChatronOlivier CollangeFrançois DanionFrédéric de BlayEric DemonsantPierre DiemunschSophie DiemunschRenaud FeltenBernard GoichotValentin GreigertAurélien GuffroyBob HegerAnne HuttCharlotte KaeufferLoic KassegneAnne Sophie KorganowPierrick Le BorgneNicolas LefebvreTristan MartinPaul Michel MertesCatherine MetzgerNicolas MeyerGabriel NisandEric NollMathieu OberlinSophie Ohlmann-CaillardVincent PoindronJulien PottecherYvon RuchCédric SublonHakim TayebiFrançois WeillArsène MékinianDorothée ChopinOlivier FainMarc GarnierJessica Krause Le GarrecMarjolaine MorgandJerome PacanowskiTomas UrbinaChloe McavoyMaria PereiraGladys AratusLaurence BerardTabassome SimonAnne Daguenel NguyenMarie AntignacCéline LeplayJean-Benoit ArletJean-Luc DiehlFlorence BellenfantAnne BlanchardAlexandre BuffetBernard CholleyAntoine FayolEdouard FlamarionAnne GodierThomas GorgetSophie-Rym HamadaCaroline Hauw-BerlemontJean- Sébastien HulotDavid LebeauxMarine LivrozetAdrien MichonArthur NeuschwanderMarie-Aude PenetBenjamin PlanquetteBrigitte RanqueOlivier SanchezGeoffroy VolleSandrine BrioisMathias CornicVirginie EliseeDenis, JesuthasanJuliette Djadi-PratPauline JouanyRamon JunqueraMickael HenriquesAmina KebirIsabelle LehirJeanne MeunierFlorence PatinValérie PaquetAnne TréhanVéronique VignaBrigitte SabatierDamien BergerotCharlène JouveCamille KnospOlivia LenoirNassim MahtalLéa ResminiXavier LescureJade GhosnAntoine BachelardTimothee BironneRaphaël BorieAgathe BounhiolCatherine BoussardJeanne ChauffierSolaya ChalalLynda ChalalMalikhone ChansombatPaul CrespinBruno CrestaniOlivia DaconceicaoLaurene DeconinckHilippe DieudeAntoine DossierMarie DubertGreggory DucrocqAxelle FuentesAnne GervaisMarie GilbertValentina IserniaSophie IsmaelVeronique JolyZelie JuliaSylvie LarivenSylvie Le GacDiane Le PluartFrancoise LouniAwa NdiayeThomas PapoMarion PariseyBao PhungAnnabelle PourbaixAnne RachlineChristophe RiouxAurelie SautereauPhilippe Gabriel StegHassan ThariniSimon ValayerDorothee ValloisPaul VermesThomas VolpeYann NguyenVasco HonselEmmanuel WeissAnaïs CodorniuVirginie ZarroukVictoire de LastoursMatthieu UzzanNaura GamanyRoza RahliZeina LouisDavid BoutboulLionel GalicierYaël AmaraGabrielle ArcherAmira BenattiaAnne BergeronLouise BondeelleNathalie de CastroMelissa ClémentMichaël DarmontBlandine DenisClairelyne DupinElsa FeredjDelphine FeyeuxAdrien JosephEtienne LenglinéPierre Le GuenGeoffroy LiégeonGwenaël LorillonAsmaa MabroukiEric MariotteGrégoire Martin de FrémontAdrien MirouseJean-Michel MolinaRégis Peffault de LatourÉric OksenhendlerJulien SaussereauAbdellatif TaziJean-Jacques TudesqLara ZafraniIsabelle BrindeleEmmanuelle BugnetKarine Celli LebrasJulien ChabertLalia DjaghoutCatherine FauvauxAnne Lise JeguEwa KozaliewiczMartine MeunierMarie-Thérèse TremorinClaire DavoineIsabelle MadeleineSophie Caillat-ZucmanConstance DelaugerreFlorence MorinDamien SèneRuxandra BurlacuBenjamin ChoustermanBruno MégarbaneP. RichetteJean-Pierre RivelineAline FrazierÉric VicautLaure BertonTassadit HadjamMiguel Alejandro Vasquez-IbarraClément JourdaineAude JacobJulie SmatiStéphane RenaudPhilippe ManivetClaire PerninLydia SuarezLuca SemeranoSébastien AbadRuben BenainousCoralie Bloch QueyratNicolas BonnetSabrina BrahmiJohann CailholYves CohenCeline ComparonHugues CordelRobin DhoteNathalie DournonBoris DuchemannNathan EbsteinBenedicte Giroux-LeprieurJeanne Goupil de BouilleAnne JacolotHilario NunesJohanna OzielVanessa RathouinMarthe RigalDominique RoulotClaire TantetYurdagül UzunhanNathalie Costedoat-ChalumeauZakaria Ait HamouSarah BenghanemPhilippe BlancheEtienne CanouiNicolas CarlierBenjamin ChaigneAdrien ContejeanBertrand DunoguePierre DuplandAurélie Durel - MaurisseRémy GauzitPaul JaubertHassan JoumaaMathieu JozwiakSolen KernéisMarie LachatreHélène LafoestePaul LegendreLiem Binh Luong NguyenJonathan MareyCaroline MorbieuLuc MouthonLee NguyenLola-Jade PalmieriAlexis RégentTali-Anne SzwebelBenjamin TerrierCorinne GuerinJérémie ZerbitKahina CherefKamil ChitourMamadou Salif CisseAda ClarkeGaelle ClavereIsabelle DusanterCaroline GaudefroyMoez JallouliSami KoltaCatherine Le BourloutNathalie MarinNathalie MenageAlexandre MooresIsabelle PeigneyCédric PierronSamira Saleh-MghirMathilde ValletMarc MichelGiovanna MelicaJean-Daniel LelievreElena FoisPascal LimMarie MatignonConstance GuillaudAlaki ThiemeleDavid SchmitzMarion BouhrisSyllia BelazouzLaetitia LanguilleArmand Mekontso-DessapsThiziri SadaouiJulien MayauxPatrice CacoubJean-Christophe CorvolCéline LouapreSara SambinLouise-Laure MarianiKirsten Müller-VahlFlorence TubachCandice EstellatLinda GimenoKarine MartinAïcha BahVixra KeoSabrine OuamriYasmine MessaoudiNessima YellesPierre FayeSébastien CavelotCecile LarchevequeLaurence AnnonayJaouad BenhidaAida Zahrate-GhoulSoumeya HammalRidha BelilitaMarie LecronierAlexandra BeurtonLuc HaudebourgRobin DelerisJulien Le MarecSara VirolleSafaa NemlaghiCôme BureauPierre MoraMartin de SarcusOlivier ClovetBaptiste DuceauPaul Henri GrisotMarie Hélène PariJérémy ArzoineUlrich ClaracMorgane FaureJulie DelemazureMaxence DecaveleElise MorawiecAlexandre DemouleMartin DresMathieu VautierYves AllenbachOlivier BenvenisteGaelle LerouxAude RigoletPerrine Guillaume-JugnotFanny DomontAnne Claire DesboisCloé ComarmondNicolas ChamptiauxSegolene ToquetAmine GhembazaMatheus VieiraGeorgina MaaloufGonçalo BoletoYasmina FerfarFanny CharbonnierClaire AguilarFanny Alby-LaurentMarie-Alexandra AlyanakianPrissile BakouboulaChristine BroissandCarole BurgerClara Campos-VegaNathalie ChavarotLaure ChoupeauxCaroline ElieBenjamin FournierSophie GranvilleElodie IssoratClaire RouzaudDamien VimpereGuillaume GeriNawal DerridjNaima SguiouarHakim MeddahMourad DjadelHelene Chambrin-LauvrayJean-Charles Duclos-ValléeFaouzi SalibaSophie-Caroline SacleuxIlias KoumisJean-Marie MichotAnnabelle StoclinEmeline ColombaFanny PommeretChistophe WillekensRosa da SilvaValérie DejeanYasmina MekidInes Ben-MabroukCaroline PradonLaurence DrouardValérie Camara-ClayetteAlexandre MorelGilles GarciaAbolfazl MohebbiFérial BerbourMélanie DehaisAnne-Lise PouliquenAlison KlasenLoren Soyez-HerkertJonathan LondonYounes KeroumiEmmanuelle GuillotGuillaume GraillesYounes El AmineFanny DefrancqHanane FodilChaouki BourasDominique DautelNicolas GambierThierno DieyeBoris BienvenuVictor LanconLaurence LecomteKristina BeziriganyanBelkacem AsselateLaure AllanicElena KiourisMarie-Hélène LegrosChristine LemagnerPascal MartelVincent ProvitoloFélix AckermannMathilde Le MarchandAurélie Clan Hew WaiDimitri FremontElisabeth CoupezMireille AddaFrédéric DuéeLise BernardAntoine GrosEstelle HenryClaire CourtinAnne PattynPierre-Grégoire GuinotMarc BardouAgnes MaurerJulie JambonAmélie Cransac-MietCorinne PernotBruno MourvillierAmélie ServettazGaetan DesléeAlain WynckelPhilippe BenoitEric MarquisDamien RouxCoralie GernezCécile YelnikJulien PoissyMandy NizardFanette DeniesHélène GrosJean-Jacques MouradEmmanuelle SaccoSophie Renet
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Organismes :
Hôpital Necker - Enfants Malades [AP-HP]
Imagine - Institut des maladies génétiques (IHU)
Service de Rhumatologie [CHU Bicêtre]
Immunologie des Maladies Virales et Autoimmunes
Paris-Centre de Recherche Cardiovasculaire
Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation | Epidémiologie Clinique, STatistique, pour la Recherche en Santé
Hopital Saint-Louis [AP-HP]
Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
Assistance publique - Hôpitaux de Paris (AP-HP)
Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
Centre d'épidémiologie Clinique [Hôtel-Dieu]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Saint-Antoine [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
CHU Saint-Antoine [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Tenon [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
Neurophysiologie Respiratoire Expérimentale et Clinique
CHU Pitié-Salpêtrière [AP-HP]
Centre de recherche en Myologie – U974 SU-INSERM
CHU Pitié-Salpêtrière [AP-HP]
Centre de recherche en Myologie – U974 SU-INSERM
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
- Publié dans JAMA Internal Medicine le 31/10/2020
Résumé : Importance Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19). Objective To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia. Design, Setting, and Particpants This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days. Patients were recruited from 9 university hospitals in France. Analyses were performed on an intention-to-treat basis with no correction for multiplicity for secondary outcomes. Interventions Patients were randomly assigned to receive TCZ, 8 mg/kg, intravenously plus usual care on day 1 and on day 3 if clinically indicated (TCZ group) or to receive usual care alone (UC group). Usual care included antibiotic agents, antiviral agents, corticosteroids, vasopressor support, and anticoagulants. Main Outcomes and Measures Primary outcomes were scores higher than 5 on the World Health Organization 10-point Clinical Progression Scale (WHO-CPS) on day 4 and survival without need of ventilation (including noninvasive ventilation) at day 14. Secondary outcomes were clinical status assessed with the WHO-CPS scores at day 7 and day 14, overall survival, time to discharge, time to oxygen supply independency, biological factors such as C-reactive protein level, and adverse events. Results Of 131 patients, 64 patients were randomly assigned to the TCZ group and 67 to UC group; 1 patient in the TCZ group withdrew consent and was not included in the analysis. Of the 130 patients, 42 were women (32%), and median (interquartile range) age was 64 (57.1-74.3) years. In the TCZ group, 12 patients had a WHO-CPS score greater than 5 at day 4 vs 19 in the UC group (median posterior absolute risk difference [ARD] −9.0%; 90% credible interval [CrI], −21.0 to 3.1), with a posterior probability of negative ARD of 89.0% not achieving the 95% predefined efficacy threshold. At day 14, 12% (95% CI −28% to 4%) fewer patients needed noninvasive ventilation (NIV) or mechanical ventilation (MV) or died in the TCZ group than in the UC group (24% vs 36%, median posterior hazard ratio [HR] 0.58; 90% CrI, 0.33-1.00), with a posterior probability of HR less than 1 of 95.0%, achieving the predefined efficacy threshold. The HR for MV or death was 0.58 (90% CrI, 0.30 to 1.09). At day 28, 7 patients had died in the TCZ group and 8 in the UC group (adjusted HR, 0.92; 95% CI 0.33-2.53). Serious adverse events occurred in 20 (32%) patients in the TCZ group and 29 (43%) in the UC group (P = .21). Conclusions and Relevance In this randomized clinical trial of patients with COVID-19 and pneumonia requiring oxygen support but not admitted to the intensive care unit, TCZ did not reduce WHO-CPS scores lower than 5 at day 4 but might have reduced the risk of NIV, MV, or death by day 14. No difference on day 28 mortality was found. Further studies are necessary for confirming these preliminary results. Trial Registration ClinicalTrials.gov Identifier: NCT04331808
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