Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients

© 2021. The Author(s)..

BACKGROUND: Critical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ.

METHODS: From September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy.

RESULTS: Among non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p < 0.05), than the standard therapy group. All HD patients in the standard therapy group with oxygen demand exceeding 8 L/min died. Contrastingly, all patients in the TCZ + mPSL pulse group survived, with their oxygen demand decreasing to 0-1 L/min within 3 weeks post-administration.

CONCLUSION: TCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation.

Media Type:

Electronic Article

Year of Publication:

2022

Contained In:

Clinical and experimental nephrology - Vol. 26, No. 1 (2022), p. 75-85

Language:

English

Contributors:

Toda, Masataro
Fujii, Kentaro
Yoshifuji, Ayumi
Kondo, Yasushi
Itoh, Kazuto
Sekine, Kazuhiko
Kikuchi, Takahide
Ryuzaki, Munekazu

Links:

Volltext

Keywords:

*Renal Dialysis
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents
Antibodies, Monoclonal, Humanized
COVID-19
Cytokine Release Syndrome
Cytokine storms
Drug Therapy, Combination
Female
Glucocorticoids
Hemodialysis
Humans
I031V2H011
Journal Article
Kidney Diseases
Male
Methylprednisolone
Middle Aged
Pulse Therapy, Drug
Retrospective Studies
Steroid pulse therapy
Time Factors
Tocilizumab
Treatment Outcome
X4W7ZR7023

Notes:

Date Completed 12.01.2022

Date Revised 12.01.2022

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1007/s10157-021-02126-4

PMID:

34436742

PPN (Catalogue-ID):

NLM33098442X