这两天在网上逛的时候看到了一篇美国University of Michigan已经被“Clinical Infectious Diseases”接收的文章，对新冠危重症插管病人做了应用托珠单抗(Tocilizumab)和常规治疗的对比实验，结果相当不错。从 表二的fatality rate来看二者的差别很显著(p-value<0.01)，Discharged alive的差别也类似(p-value=0.04)。Remdesivir对这类病人已经基本无能为力。文中托珠单抗的用法是" The standard tocilizumab dose was 8 mg/kg (maximum 800 mg) x 1; additional doses were discouraged." 中国标准用法在first dose效果不好时会有second dose，四月还有篇文章说小量multiple doses效果最好，不知道为什么他们没有采纳。 https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa954/5870306#.Xwn1zOa1-bY.twitter Results 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.58 (0.36, 0.94)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; p<0.001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection [22% vs. 15%; p=0.42]. Staphylococcus aureus accounted for ~50% of bacterial pneumonia.
这两天在网上逛的时候看到了一篇美国University of Michigan已经被“Clinical Infectious Diseases”接收的文章，对新冠危重症插管病人做了应用托珠单抗(Tocilizumab)和常规治疗的对比实验，结果相当不错。从 表二的fatality rate来看二者的差别很显著(p-value<0.01)，Discharged alive的差别也类似(p-value=0.04)。Remdesivir对这类病人已经基本无能为力。文中托珠单抗的用法是" The standard tocilizumab dose was 8 mg/kg (maximum 800 mg) x 1; additional doses were discouraged." 中国标准用法在first dose效果不好时会有second dose，四月还有篇文章说小量multiple doses效果最好，不知道为什么他们没有采纳。 https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa954/5870306#.Xwn1zOa1-bY.twitter Results 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.58 (0.36, 0.94)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; p<0.001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection [22% vs. 15%; p=0.42]. Staphylococcus aureus accounted for ~50% of bacterial pneumonia. genechn 发表于 2020-07-21 09:57
https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa954/5870306#.Xwn1zOa1-bY.twitter
Results 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.58 (0.36, 0.94)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; p<0.001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection [22% vs. 15%; p=0.42]. Staphylococcus aureus accounted for ~50% of bacterial pneumonia.
这个样本小了一点，现在大家都在等的是remdesivir和免疫抑制单抗联合用药的三期临床结果。
看了一下上面IPTW adj就是针对年龄和其它差别做的修正，修正后的结果还可以。
嗯，这个值得期待。看上面的文章羟氯喹和托珠单抗联用效果不好，两者都有压制免疫的作用，remdesivir仅仅是杀病毒。
好消息，谢分享
美国真是太教条了！
美国应该不是简单教条
是自大和对生命的冷漠，从川普到美国医界都是这样。
美国只看到盖茨 呼吁 不要忽视美国的弱势群体
Tocilizumab 对应是炎症风暴，主要就是身体好好，突然就不行，很多年轻的人死掉，都是炎症风暴原因，针对危重症的病人
羟氯喹：主要减低爆发炎症风暴，就是轻症的吃。