Hospitalized coronavirus disease 2019 (COVID-19) patients who received interleukin-6 inhibitors (IL-6i) had reduced odds of in-hospital COVID-related mortality, according to a study published in The Journal of Infectious Diseases.
Investigators analyzed data from 516 patients aged 18 and older who were admitted to 1 of 4 affiliated US hospitals with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test. Of the 516 patients, 104 (20.1%) received IL-6i.
At admission, patients receiving IL-6i had significantly lower PaO2:FiO2 ratios (316.82 vs 373.72; P <.001), higher mean C reactive protein (129.44 vs 98.23 mg/L; P =.003), higher mean lactate dehydrogenase (453.83 vs 387.16 U/L; p = .021), and higher mean prothrombin time (16.69 vs 13.27 seconds; P =.013).
Of the 104 patients exposed to IL-6i, 16 (15.4%) were already in the intensive care unit or on ventilation when they received this treatment. In this cohort, 33 patients (24.6%) were later admitted to the intensive care unit and 23 patients (22.1%) later required ventilation. In patients who were not exposed to IL-6i, 73 (17.8%) required mechanical ventilation.
In terms of unadjusted frequency, 13 patients who received IL-6i treatment died (12.5%) compared with 46 patients (11.2%) who did not receive IL-6i treatment. Further analyses indicated a 37% reduction in the odds of in-hospital mortality for patients who received IL-6i (odds ratio, 0.63; 95% CI, 0.29-1.38). In a sensitivity analysis, investigators obtained an E-value of 2.55.
Due to the observational nature of the study, bias by unmeasured or uncontrolled confounding is a possibility, however, a sensitivity analysis was performed to estimate the magnitude of residual confounding.
According to investigators this work identified “a signal for the beneficial effect of IL-6i therapy on reduction of in-hospital mortality, albeit with low precision.” They believe this data can further inform clinical care while waiting for more data from randomized control trials.
Sinha P, Jafarzadeh SR, Assoumou SA, et al. The effect of IL-6 inhibitors on mortality among hospitalized COVID-19 patients: a multicenter study. J Infect Dis. Published online November 20, 2020. doi:10.1093/infdis/jiaa717.