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

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...

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Autores: Rodríguez-Baño, Jesús, Pachón Díaz, Jerónimo, Carratalà, Jordi, Ryan, Pablo, Jarrín, Inmaculada, Yllescas, María, Arribas, José Ramón, Berenguer, Juan
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/135303
Acceso en línea:https://hdl.handle.net/11441/135303
https://doi.org/10.1016/j.cmi.2020.08.010
Access Level:acceso abierto
Palabra clave:Cohort study
Corticosteroids
COVID-19
Hyperinflammatory state
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spelling Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)Rodríguez-Baño, JesúsPachón Díaz, JerónimoCarratalà, JordiRyan, PabloJarrín, InmaculadaYllescas, MaríaArribas, José RamónBerenguer, JuanCohort studyCorticosteroidsCOVID-19Hyperinflammatory stateObjectives 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).Science DirectMedicinaInstituto Carlos III (España)Unión Europea2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/135303https://doi.org/10.1016/j.cmi.2020.08.010reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésClinical Microbiology and Infection, 27 (2), 244-252.https://reader.elsevier.com/reader/sd/pii/S1198743X20304924?token=031722D2E384576E74E54CD294E23F8A194DC93334B6531A1847E78C5FF4AB245F31CABC3412B7D5C4AB41DE21023518&originRegion=eu-west-1&originCreation=20220713101841info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1353032026-06-17T12:51:07Z
dc.title.none.fl_str_mv Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
title Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
spellingShingle Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
Rodríguez-Baño, Jesús
Cohort study
Corticosteroids
COVID-19
Hyperinflammatory state
title_short Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
title_full Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
title_fullStr Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
title_full_unstemmed Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
title_sort Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
dc.creator.none.fl_str_mv Rodríguez-Baño, Jesús
Pachón Díaz, Jerónimo
Carratalà, Jordi
Ryan, Pablo
Jarrín, Inmaculada
Yllescas, María
Arribas, José Ramón
Berenguer, Juan
author Rodríguez-Baño, Jesús
author_facet Rodríguez-Baño, Jesús
Pachón Díaz, Jerónimo
Carratalà, Jordi
Ryan, Pablo
Jarrín, Inmaculada
Yllescas, María
Arribas, José Ramón
Berenguer, Juan
author_role author
author2 Pachón Díaz, Jerónimo
Carratalà, Jordi
Ryan, Pablo
Jarrín, Inmaculada
Yllescas, María
Arribas, José Ramón
Berenguer, Juan
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Instituto Carlos III (España)
Unión Europea
dc.subject.none.fl_str_mv Cohort study
Corticosteroids
COVID-19
Hyperinflammatory state
topic Cohort study
Corticosteroids
COVID-19
Hyperinflammatory state
description 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).
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/135303
https://doi.org/10.1016/j.cmi.2020.08.010
url https://hdl.handle.net/11441/135303
https://doi.org/10.1016/j.cmi.2020.08.010
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Clinical Microbiology and Infection, 27 (2), 244-252.
https://reader.elsevier.com/reader/sd/pii/S1198743X20304924?token=031722D2E384576E74E54CD294E23F8A194DC93334B6531A1847E78C5FF4AB245F31CABC3412B7D5C4AB41DE21023518&originRegion=eu-west-1&originCreation=20220713101841
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Science Direct
publisher.none.fl_str_mv Science Direct
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
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