Background
Cardiac injury and dysfunction are common in COVID-19. Our objective was to test if tocilizumab, an interleukin (IL)-6 receptor antagonist, is associated with a reduction in concentrations of troponin or natriuretic peptides among hospitalized patients with COVID-19.
Methods
This study analyzed data from a randomized, double-blind, placebo-controlled trial conducted at seven sites across Boston from April 20 to June 16, 2020. The trial enrolled 243 adults hospitalized with confirmed SARS-CoV-2 infection and serological evidence of systemic inflammation plus fever or pulmonary involvement. Patients were randomized in a 2:1 fashion to tocilizumab (8mg/kg) or placebo, plus standard care.
Results
Among the study participants, 83/242 had an elevated troponin level, and 119/235 had an elevated natriuretic peptide level at study entry. There was no significant difference in the proportion of participants with a ≥20% reduction in either troponin (23.8% vs. 31.0%, P=0.10) or natriuretic peptide (57.0% vs. 44.3%, P=0.07) levels, between those randomized to tocilizumab as compared to placebo. In exploratory analyses, tocilizumab was associated with a ≥20% reduction in natriuretic peptide level among patients 65 years of age or younger, patients of Hispanic ethnicity, and those with a BMI ≥30 kg/m2. Elevations in troponin (Hazard ratio (HR), 3.35 [95% CI 1.53 - 7.32], P=0.002), natriuretic peptide (HR, 3.58 [95% CI 1.44 - 8.86, P=0.006]) and the combination of both an elevated troponin and natriuretic peptide levels (HR, 5.10 [95% CI 1.87 - 13.93, P=0.002]) at study entry were strong predictors for the risk for subsequent mechanical ventilation or death.
Conclusion
Tocilizumab was not associated with an obvious reduction in either troponin or natriuretic peptide levels at Day 4 among patients hospitalized with COVID-19. Both troponin and natriuretic peptide levels were robust predictors of the need for mechanical ventilation or death among patients hospitalized with COVID-19.ClinicalTrials.gov Identifier: NCT04356937
Footnotes
Moderated Poster Contributions Saturday, May 15, 2021, 10:45 a.m.-10:55 a.m.
Session Title: Markers to Measure Mortality: Biomarkers, Inflammatory Markers and Other Markers of Outcomes in Patients with COVID-19 Infection
Abstract Category: 61. Spotlight on Special Topics: Coronavirus Disease (COVID-19)
Presentation Number: 1088-09