Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection : A Spanish, Multicenter, Cohort Study
Ruiz-Antorán, Belén (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Sancho López, Aranzazu (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Torres, Ferrán (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
Moreno-Torres, Víctor (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
de Pablo-López, Itziar (Instituto Ramón y Cajal de Investigación Sanitaria (Madrid))
García-López, Paulina (Complejo Hospitalario Torrecárdenas (Almeria))
Abad-Santos, Francisco (Instituto de Investigación Hospital Universitario de la Princesa)
Rosso-Fernández, Clara M. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Aldea-Perona, Ana (Institut Hospital del Mar d'Investigacions Mèdiques)
Montané Esteva, Eva (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Aparicio-Hernández, Ruth M. (Hospital Universitario Central de La Defensa Gómez Ulla)
Llop-Rius, Roser (Hospital Universitari de Bellvitge)
Pedrós, Consuelo (Hospital General Universitario de Valencia)
Gijon, Paloma (Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM))
Hernández-Carballo, Carolina (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Pedrosa-Martínez, María J. (Hospital Universitario Puerto Real (Cadis))
Rodríguez-Jiménez, Consuelo (Universidad de La Laguna. Departamento de Medicina Física y Farmacología)
Prada-Ramallal, Guillermo (Instituto de Investigación Sanitaria de Santiago (IDIS))
Cabrera-García, Lourdes (Hospital Clínico San Carlos (Madrid))
Aguilar-García, Josefa A. (Hospital Costa del Sol (Marbella))
Sanjuan-Jimenez, Rocío (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
Ortiz-Barraza, Evelyn I. (Hospital Universitario Ramón y Cajal (Madrid))
Sánchez-Chica, Enrique (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Fernández-Cruz, Ana (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))

Date:	2020
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Estudi clínic ; recerca ; Versió publicada
Subject:	COVID-19 ; Mortality ; SARS-CoV-2 ; Steroids ; Tocilizumab
Published in:	Infectious Diseases and Therapy, Vol. 10 (march 2021) , p. 347-362, ISSN 2193-6382

DOI: 10.1007/s40121-020-00373-8
PMID: 33280066

16 p, 896.7 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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