Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection

We aimed to determine the impact of tocilizumab use on severe COVID-19 (coronavirus disease 19) pneumonia mortality. We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocil...

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Detalhes bibliográficos
Autores: Ruiz-Antorán, Belén|||0000-0002-2020-9077, Sancho López, Aranzazu|||0000-0002-6192-4464, Torres, Ferran|||0000-0002-7355-7913, Moreno-Torres, Víctor|||0000-0002-9798-4514, de Pablo-López, Itziar, García-López, Paulina, Abad-Santos, Francisco|||0000-0002-6519-8885, Rosso-Fernández, Clara M., Aldea-Perona, Ana|||0000-0002-3791-8814, Montané Esteva, Eva|||0000-0002-1691-7652, Aparicio-Hernández, Ruth M., Llop-Rius, Roser, Pedrós, Consuelo, Gijon, Paloma|||0000-0002-5011-1927, Hernández-Carballo, Carolina, Pedrosa-Martínez, María J., Rodríguez-Jiménez, Consuelo, Prada-Ramallal, Guillermo, Cabrera-García, Lourdes, Aguilar-García, Josefa A., Sanjuán Jiménez, Rocío, Ortiz-Barraza, Evelyn I., Sánchez-Chica, Enrique, Fernández-Cruz, Ana
Formato: informe técnico
Fecha de publicación:2020
País:España
Recursos:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:238677
Acesso em linha:https://ddd.uab.cat/record/238677
https://dx.doi.org/urn:doi:10.1007/s40121-020-00373-8
Access Level:acceso abierto
Palavra-chave:COVID-19
Mortality
SARS-CoV-2
Steroids
Tocilizumab
Descrição
Resumo:We aimed to determine the impact of tocilizumab use on severe COVID-19 (coronavirus disease 19) pneumonia mortality. We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by inverse probability of the treatment weights (IPTW). Tocilizumab's effect in patients receiving steroids during the 48 h following inclusion was analysed. During the study period, 506 patients with severe COVID-19 fulfilled the inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days [interquartile range (IQR) 8-14]. Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls: 16.8% versus 31.5%, hazard ratio (HR) 0.514 [95% confidence interval (95% CI) 0.355-0.744], p < 0.001; weighted HR 0.741 (95% CI 0.619-0.887), p = 0.001. Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment [relative risk reduction (RRR) 46.7%]. We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in those treated with tocilizumab than in those treated with steroids alone [10.9% versus 40.2%, HR 0.511 (95% CI 0.352-0.741), p = 0.036; weighted HR 0.6 (95% CI 0.449-0.804), p < 0.001] (interaction p = 0.094). These results show that survival of patients with severe COVID-19 is higher in those treated with tocilizumab than in those not treated and that tocilizumab's effect adds to that of steroids administered to non-intubated patients with COVID-19 during the first 48 h of presenting with respiratory failure despite oxygen therapy. Randomised controlled studies are needed to confirm these results. European Union electronic Register of Post-Authorization Studies (EU PAS Register) identifier, EUPAS34415 The online version of this article (10.1007/s40121-020-00373-8) contains supplementary material, which is available to authorized users.

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