Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

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 We conducted a retrospective single-center study including consecutive patients ≥65 years that developed severe COVID-19 between March 3 and May 1, 2020 and were treated with corticosteroids at various doses (methylprednisolone [0.5 mg/Kg/12 hours to 250 mg/24 hours]), either alone (“CS group”) or associated to intravenous tocilizumab (400-600 mg, one to three doses) (“CS-TCZ group”). 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 six-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied.Results Overall, 181 and 80 patients were included in the CS and CS-TCZ groups. 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-value = 0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21 – 0.68;P-value = 0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21 – 0.72;P-value = 0.003). Clinical improvement by day +14 was higher in the CS-TCZ group in the IPTW analysis only (OR: 2.26; 95% CI: 1.49 – 3.41;P-value <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 ≥65 years with severe COVID-19..

Media Type:

Electronic Article

Year of Publication:

2021

Publication:

2021

Contained In:

bioRxiv.org - (2021) vom: 05. Apr. To Main Record - year:2021

Language:

English

Contributors:

López-Medrano, Francisco [Author]
Pérez-Jacoiste Asín, María Asunción [Author]
Fernández-Ruiz, Mario [Author]
Carretero, Octavio [Author]
Lalueza, Antonio [Author]
de la Calle, Guillermo Maestro [Author]
Caro, José Manuel [Author]
de la Calle, Cristina [Author]
Catalán, Mercedes [Author]
García-García, Rocío [Author]
Martínez-López, Joaquín [Author]
Origüen, Julia [Author]
Ripoll, Mar [Author]
Juan, Rafael San [Author]
Trujillo, Hernando [Author]
Sevillano, Ángel [Author]
Gutiérrez, Eduardo [Author]
de Miguel, Borja [Author]
Aguilar, Fernando [Author]
Gómez, Carlos [Author]
Silva, José Tiago [Author]
de Morales, Daniel García-Ruiz [Author]
Saro-Buendía, Miguel [Author]
Marrero-Sánchez, Ángel [Author]
Chiara-Graciani, Guillermo [Author]
Bueno, Héctor [Author]
Paz-Artal, Estela [Author]
Lumbreras, Carlos [Author]
Pablos, José L. [Author]
Aguado, José María [Author]

Links:

Volltext [Kostenfrei]

doi:

10.1101/2020.09.26.20202283

PPN (Catalogue-ID):

XBI018860311