Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: A single-center retrospective study. (April 2021)

• Record Type: Journal Article
• Authors: López-Medrano, Francisco; Pérez-Jacoiste Asín, María Asunción; Fernández-Ruiz, Mario; Carretero, Octavio; Lalueza, Antonio; Maestro de la Calle, Guillermo; Caro, José Manuel; de la Calle, Cristina; Catalán, Mercedes; García-García, Rocío; Martínez-López, Joaquín; Origüen, Julia; Ripoll, Mar; San Juan, Rafael; Trujillo, Hernando; Sevillano, Ángel; Gutiérrez, Eduardo; de Miguel, Borja; Aguilar, Fernando; Gómez, Carlos; Silva, José Tiago; García-Ruiz de Morales, Daniel; Saro-Buendía, Miguel; Marrero-Sánchez, Ángel; Chiara-Graciani, Guillermo; Bueno, Héctor; Paz-Artal, Estela; Lumbreras, Carlos; Pablos, José L.; Aguado, José María
• Is Part Of: International journal of infectious diseases. Volume 105(2021)
• Page Start: 487
• Page End: 494
• Publication Date: 2021-04
• Subjects: COVID-19 -- SARS-CoV-2 -- Tocilizumab -- Corticosteroids -- Therapy -- Immunomodulation -- Outcome -- Mortality; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.02.099
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: An increasing number of immunomodulatory therapies are being tested for COVID-19. A survival benefit has been shown with the use of corticosteroids. The role of combination therapy with corticosteroids and tocilizumab is unclear. This study analyzed a single-center cohort of patients aged ≥65 years with severe COVID-19. The sequential use of corticosteroids and tocilizumab was associated with better outcomes. Abstract: Background: The role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear. Methods: A retrospective single-center study was conducted on consecutive patients aged ≥65 years who developed severe COVID-19 between 03 March and 01 May 2020 and were treated with corticosteroids at various doses (methylprednisolone 0.5 mg/kg/12 h to 250 mg/24 h), either alone (CS group) or associated with intravenous tocilizumab (400–600 mg, one to three doses) (CS-TCZ group). The primary outcome was all-cause mortality by day +14, whereas secondary outcomes included mortality by day +28 and clinical improvement (discharge and/or a ≥2 point decrease on a 6-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied. Results: Totals of 181 and 80 patients were included in the CS and CS-TCZ groups, respectively. All-cause 14-day mortality was lower in the CS-TCZ group, both in the PS-adjusted (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.17–0.68; P = 0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21–0.68; P = 0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21–0.72; P = 0.003). Clinical improvement by day +14 was higher in the CS-TCZ group with IPTW analysis only (OR: 2.26; 95% CI: 1.49–3.41; P < 0.001). The occurrence of secondary infection was similar between both groups. Conclusions: The combination of corticosteroids and TCZ was associated with better outcomes among patients aged ≥65 years with severe COVID-19.