Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19). (February 2021)

• Record Type: Journal Article
• Authors: Rodríguez-Baño, Jesús; Pachón, Jerónimo; Carratalà, Jordi; Ryan, Pablo; Jarrín, Inmaculada; Yllescas, María; Arribas, José Ramón; Berenguer, Juan; Aznar Muñoz, Esther; Gil Divasson, Pedro; González Muñiz, Patricia; Muñoz Aguirre, Clara; Díaz Menéndez, Marta; de la Calle Prieto, Fernando; Arsuaga Vicente, Marta; Trigo Esteban, Elena; Pérez Valero, Ignacio; de Miguel Buckley, Rosa; Cadiñaños Loidi, Julen; Diaz Pollan, Beatriz; Martín Carbonero, Luz; Ramos Ramos, Juan Carlos; Loeches Yagüe, Belén; Montejano Sánchez, Rocío; González García, Juan; García Rodríguez, Julio; Berenguer, Juan; Ramírez, Margarita; Gutiérrez, Isabel; Tejerina, Francisco; Aldámiz-Echevarría, Teresa; Díez, Cristina; Fanciulli, Chiara; Pérez-Latorre, Leire; Pinilla, Blanca; López, Juan Carlos; Such Diaz, Ana; Álvaro Alonso, Elena; Torres Macho, Juan; Cuevas Tascon, Guillermo; Jiménez González de Buitrago, Eva; Brañas Baztán, Fátima; Valencia de la Rosa, Jorge; Pérez Butragueño, Mario; Fernández Jiménez, Inés; Muñiz Nicolás, Gemma; Sepúlveda Berrocal, Antonia; Gato Díez, Alberto; Toledano Sierra, María Pilar; García Butenegro, María Paz; Peláez Ballesta, Ana Isabel; Morcillo Rodríguez, Elena; Fernández Romero, Isidoro; Peláez Ballesta, Cristina; Guirado Torrecillas, María Isabel; Goikoetxea Agirre, Josune; Bereciartua Bastarrica, Elena; Guio Carrión, Laura; Rodríguez Álvarez, Regino; Ibarrola Hierro, Marta; Pérez Hernández, Isabel A.; Pérez Zapata, Inés; Román Soto, Sergio; Kallouchi, Mohamed; Domínguez Vicent, Juan Ramón; Silvariño Fernández, Rafae; Ugalde Espiñeira, Jon; Sanjuan López, Ainhoa; García Martínez, Silvia; Temprano Gogenola, Mikel; Asensi, Víctor; Suárez, Silvia; Suárez, Lucia; Yllera, Carmen; Rivas-Carmenado, María; Romero-Palacios, Alberto; Ruiz Aragón, Jesús; Jiménez Aguilar, Patricia; Fernández Ávila, Ma Luisa; Castilla Ortiz, Rosario; Alende Castro, Vanesa; Pérez García, Cristina; Fernández Morales, Marta; Valle Feijoo Begoña Rodríguez Ferreira, María Lorena María; Gómez-Junyent, Joan; Villar-García, Judit; López-Montesinos, Inmaculada; Arrieta-Aldea, Itziar; Rial-Villavecchia, Abora; García Vázquez, Elisa; Roura Piloto, Aychel Elena; Moral Escudero, Encarnación; Hernández Torres, Alicia; Albendín Iglesias, Helena; Vinuesa García, David; Martínez Montes, Clara; De la Hera Fernández, Francisco Javier; Anguita Santos, Francisco; Ruiz Sancho, Andrés; Díaz de Brito Fernández, Vicens; Sanmarti Vilamala, Montserrat; España Cueto, Sergio; Molina Morant, Daniel; González-Cuevas, Araceli; Chara Cervantes, Joel Elías; Policarpo Torres, Guillem; Ortega Montoliu, Meritxell; Angerri Nadal, Mònica; De Genover Gil, Ariadna; Patera, Eleni; Godoy Lorenzo, Rita; Zioga, Evangelia Anna María; Isern Fernández, Virginia; Sabbagh Fajardo, Carlos Enrique; Ferrer Ribera, Ana; Bea Serrano, Carlos; Oltra Sempere, Rosa; Vela Bernal, Sara; Albiol Viñals, Paloma; Pedromingo Kus, Miguel; Garcinuño, María Ángeles; Fiorante, Silvana; Pérez Pinto, Sergio; de la Vega, Alexandra; Fariñas Álvarez, María Carmen; González Rico, Claudia; Arnaiz de las Revillas, Francisco; Giménez, Teresa; Calvo, Jorge; Meije Castillo, Yolanda; Duarte Borges, Alejandra; Pareja Coca, Júlia; Clemente Presas, Mercedes; Sanz Salvador, Xavier; Pérez Rodríguez, Ma Teresa; Sousa, Adrián; Pérez González, Alexandre; Longueira, Rebeca; Araujo, Alejandro; Alonso Martínez, Blanca; García Escudero, Laura; Lidia Kamel Rey, Sara; Roa Alonso, David; Avilés Parra, Juan Pablo; Pelegrín Senent, Iván; Rouco Esteves Marques, Rosana; Raich Montiu, Laia; Souto Higueras, Jessica; Gálvez Bobadilla, Manuel Alejandro; Parra Ruiz, Jorge; Ramos Sesma, Violeta; Velasco Fuentes, Sara; García Pereña, Laura; Lluna Carrascosa, Alfonso; Gilaberte Reyzábal, Sergio; Liébana Gómez, Mónica; Salillas Hernando, Juan; Serrano Martínez, Alberto; Torralba González de Suso, Miguel; Martínez Martín, Patricia; Rábago Lorite, Isabel; González-Ruano Pérez, Patricia; Pérez-Monte Mínguez, Beatriz; García Flores, Ángeles; Comas Casanova, Pere; Martín Plata, Andrea; Santana Báez, Sergio Manuel; Sanz Peláez, Oscar; Mohamed Ramírez, Karim; Robaina Bordón, José María; Vílchez Rueda, Helem Haydeé; Riera Jaume, Melchor; Mut Ramon, Gemma; Gavalda Manso, Meritxell; Planas Bibiloni, Lluis; Castelo Corral, Laura; Ramos Merino, Lucía; Sánchez Vidal, Efrén; Rodríguez Mayo, María; Míguez Rey, Enrique; García de Lomas Guerrero, José M.; De la Torre Lima, Javier; Correa Ruiz, Ana; Fernández Sánchez, Fernando; Jiménez-García, Nicolás; Sierra-Monzón, José Luis; Gracia-Tello, Borja; Hernández-Bonaga, María; Pellejero, Galadriel; Asín-Corrochano, Marta; Boix Palop, Lucia; Calbo, Esther; Badía, Cristina; Dietl, Beatriz; Lucía, Gómez; Domínguez-Castellano, Ángel; Ríos-Villegas, María José; del Toro, María D.; Palacios Baena, Zaira R.; Salamanca-Rivera, Elena; Marín, Elena; Almadana, Virginia; Pérez-Galera, Salvador; González-Iglesias, Luisa; Abelenda-Alonso, Gabriela; Álvarez-Pouso, Claudia; Escrihuela, Francesc; Gudiol, Carlota; Lorenzo-Esteller, Laia; Niubó, Jordi; Podzamczer, Daniel; Pujol, Miquel; Rombauts, Alexander; Salvert Lletí, Miguel; Gil Sánchez, Ricardo; Jiménez Escrig, Marta; Parra Gómez, Laura; Tasias Pitarch, Mariona; Navarro Vilasaró, Marta; Machado Sicilia, María Luisa; Gomila Grange, Aina; Calzado Isbert, Sonia; Carrasco Antón, Nerea; Petkova-Saiz, Elizabet; Cabello Úbeda, Alfonso; Górgolas Hernández-Mora, Miguel; Sánchez-Pernaute, Olga; Dueñas Gutiérrez, Carlos; Martin Guerra, Javier; Castrodeza Sanz, José Javier; Fernández Espinilla, Virginia; Rodríguez Fernández, Laura; González-Moreno, Juan; Villoslada Gelabert, Aroa; Ribot Sanso, María Antonia; Fernández-Baca, María Victoria; Hernández Milian, Almudena; Morán Rodríguez, Miguel Ángel; Ortiz de Zárate Ibarra, Zuriñe; Portu Zapirain, José Joaquin; Saez de Adana Arroniz, Ester; Gainzarain Arana, Juan Carlos; Meca Birlanga, Olga; del Amor Espín, Ma Jesús; Viqueira González, Montserrat; García García, Josefina; Martínez Madrid, Onofre; Bernal Morell, Enrique; Alcaraz, Antonia; Muñoz, Ángeles; Pina, Ignacio; de la Rosa, Vicente; Caínzos Romero, Tamara; Sánchez Trigo, Sabela; Mariño Callejo, Ana Isabel; Álvarez Díaz, Hortensia; Valcarce Pardeiro, Nieves; Sánchez Serrano, Adriana; Piñar Cabezos, Diana; García Villalba, Eva Pilar; Aguayo Jiménez, Carmen; Ruíz Campuzano, María; Naranjo Velasco, Virginia; Santos Peña, Marta; Mora Delgado, Juan; Sevilla Moreno, Israel; Lojo Cruz, Cristina; Kortajarena Urkola, Xabier; Iribarren Loyarte, José Antonio; Bustinduy Odriozola, María Jesús; Ibarguren Pinilla, Maialen; Álvarez Rodríguez, Ignacio; Martínez Marcos, Francisco Javier; Rodríguez Gómez, Francisco Javier; Asschert Agüero, Isabel; Muñoz Beamud, Francisco; Ruiz Reina, Antonio José; Llenas-García, Jara; González-Cuello, Inmaculada; Hellín-Valiente, Elena; Martínez Birlanga, Esther; Tafalla Torres, José Manuel; Calderón Parra, Jorge; Escudero López, Gabriela; Gutiérrez Martín, Isabel; Andrés Eisenhofer, Ane; García Prieto, Sonia; Álvarez Franco, Raquel; Roger Zapata, Daniel; Martínez Cifre, Blanca; Aranda Rife, Elena; Martín Rubio, Irene; Barbosa Ventura, André; Garrido, Javier; Gonzalo, Concepción; Piñero, Iván; de la Cruz Felipe, Nieves; Talavera García, Eva; Lamata Subero, Marta; Mendoza Roy, Paula; García de Carlos, María Soledad; Lajusticia Aisa, Justo; Arteche Eguizabal, Lorea; Urrutia Losada, Ainhoa; Domingo Echaburu, Saioa; Cuadros Tito, Pedro Ángel; Orbe Narváez, Gurutz; Liébana Martos, Ma del Carmen; Roldán Fontana, Carolina; Herrero Rodríguez, Carmen; Duro Ruiz, Gaspar; Pérez Parra, Santiago; Mera Fidalgo, Arantzazu; Hortos Alsina, Miquel; Alberich Conesa, Ana; Bladé Vidal, Lourdes; Merchante Gutiérrez, Nicolás; León Jiménez, Eva; Espíndola Gómez, Reinaldo; Erostarbe Gallardo, María; Martínez Pérez-Crespo, Pedro; Cisneros, José Miguel; Aguilar-Guisado, Manuela; Aldabó, Teresa; Bueno, Claudio; Cordero-Matía, Elisa; Escoresca, Ana; Infante, Carmen; Guillermo, Martín; Salto, Sonsoles; Gioia, Francesca; Vizcarra, Pilar; Fortún Abete, Jesús; Martín Dávila, Pilar; Moreno Guillén, Santiago; Oteo Revuelta, José A.; García-García, Concepción; Santibañez Sáenz, Paula; Cervera Acedo, Cristina; Azcona Gutiérrez, José M.; Reguera Iglesias, José María; Plata Ciezar, Antonio; Valiente de Santis, Lucia; Sobrino Diaz, Beatriz; Ruiz Mesa, Juan Diego;
• Is Part Of: Clinical microbiology and infection. Volume 27:Number 2(2021)
• Page Start: 244
• Page End: 252
• Publication Date: 2021-02
• Subjects: Cohort study -- Corticosteroids -- COVID-19 -- Hyperinflammatory state -- Mortality -- Tocilizumab; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2020.08.010
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation. Graphical abstract: Image 1