Comparative safety and effectiveness of tocilizumab, corticosteroids and combined therapy in SARS-COV2 infection

ABSTRACT

Objective: Tocilizumab (T) and corticosteroids (C) were two of the drugs used to stop the hyperinflammatory state of critically ill patients at the beginning of the COVID-19 pandemic. The objective of this study is to make a comparison of the efficacy and safety between the two drugs and the combination of both. Material and/or methods: All patients with SARSCOV2 infection from our centre during the first wave of the pandemic who had been treated with T, C or a combination of both (CT) were selected from the IDI-REM- 2020-01 COVID-19 Registry (NCT04347278). A descriptive study was carried out with an assessment of survival, mean stay (MS) in Intensive care unit (ICU) and risk of co-infection for these treatments. Results: Of 86 patients (54 men/32 women), 29 received T (33.7%), 37 C (43.1%) and 20 TC (23.2%). Median age was 66 ± 14 years, increasing in C (71 ± 15) and decreasing in T (60 ± 12) and TC (67 ± 13). The 48.9% of the patients with T and TC were admitted to the ICU compared to 8.1% of the patients with C, data related to age criteria. The median MS in the ICU decreased in the CT group at 7(±4) days compared to the T group (15 ± 3). There was no difference between the three therapies for general hospitalization MS (21 ± 5.5 to 23 ± 5.3). The 55.2% of the patients treated with T and 30% treated with CT had co-infection compared to 21.6% of the patients treated with C. Finally, a Kaplan-Meier analysis was performed, verifying a trend to have a longer survival in patients treated with T and CT, compared to C, although without statistical significance (χ2 0.161) by sample size. Conclusions: CT appears to be more effective than T and C in patients with severe COVID-19 disease. These results support the limited literature;however, more powered studies will be required to evaluate these results.