International Journal of Infectious Diseases (Dec 2020)

Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

  • Manuel Rubio-Rivas,
  • Mar Ronda,
  • Ariadna Padulles,
  • Francesca Mitjavila,
  • Antoni Riera-Mestre,
  • Carlos García-Forero,
  • Adriana Iriarte,
  • Jose M. Mora,
  • Nuria Padulles,
  • Monica Gonzalez,
  • Xavier Solanich,
  • Merce Gasa,
  • Guillermo Suarez-Cuartin,
  • Joan Sabater,
  • Xose L. Perez-Fernandez,
  • Eugenia Santacana,
  • Elisabet Leiva,
  • Albert Ariza-Sole,
  • Paolo D. Dallaglio,
  • Maria Quero,
  • Antonio Soriano,
  • Alberto Pasqualetto,
  • Maylin Koo,
  • Virginia Esteve,
  • Arnau Antoli,
  • Rafael Moreno-Gonzalez,
  • Sergi Yun,
  • Pau Cerda,
  • Mariona Llaberia,
  • Francesc Formiga,
  • Marta Fanlo,
  • Abelardo Montero,
  • David Chivite,
  • Olga Capdevila,
  • Ferran Bolao,
  • Xavier Pinto,
  • Josep Llop,
  • Antoni Sabate,
  • Jordi Guardiola,
  • Josep M. Cruzado,
  • Josep Comin-Colet,
  • Salud Santos,
  • Ramon Jodar,
  • Xavier Corbella

Journal volume & issue
Vol. 101
pp. 290 – 297

Abstract

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Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

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