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10.1007/s40121-020-00373-8

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33280066!7719057!33280066
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suck abstract from ncbi


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pmid33280066      Infect+Dis+Ther 2021 ; 10 (1): 347-362
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  • Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection: A Spanish, Multicenter, Cohort Study #MMPMID33280066
  • Ruiz-Antoran B; Sancho-Lopez A; Torres F; Moreno-Torres V; de Pablo-Lopez I; Garcia-Lopez P; Abad-Santos F; Rosso-Fernandez CM; Aldea-Perona A; Montane E; Aparicio-Hernandez RM; Llop-Rius R; Pedros C; Gijon P; Hernandez-Carballo C; Pedrosa-Martinez MJ; Rodriguez-Jimenez C; Prada-Ramallal G; Cabrera-Garcia L; Aguilar-Garcia JA; Sanjuan-Jimenez R; Ortiz-Barraza EI; Sanchez-Chica E; Fernandez-Cruz A
  • Infect Dis Ther 2021[Mar]; 10 (1): 347-362 PMID33280066show ga
  • BACKGROUND: We aimed to determine the impact of tocilizumab use on severe COVID-19 (coronavirus disease 19) pneumonia mortality. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: European Union electronic Register of Post-Authorization Studies (EU PAS Register) identifier, EUPAS34415.
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