Your browser doesn't support javascript.
Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection: A Spanish, Multicenter, Cohort Study.
Ruiz-Antorán, Belén; Sancho-López, Aránzazu; Torres, Ferrán; Moreno-Torres, Víctor; de Pablo-López, Itziar; García-López, Paulina; Abad-Santos, Francisco; Rosso-Fernández, Clara M; Aldea-Perona, Ana; Montané, Eva; Aparicio-Hernández, Ruth M; Llop-Rius, Roser; Pedrós, Consuelo; Gijón, Paloma; Hernández-Carballo, Carolina; Pedrosa-Martínez, María J; Rodríguez-Jiménez, Consuelo; Prada-Ramallal, Guillermo; Cabrera-García, Lourdes; Aguilar-García, Josefa A; Sanjuan-Jimenez, Rocío; Ortiz-Barraza, Evelyn I; Sánchez-Chica, Enrique; Fernández-Cruz, Ana.
  • Ruiz-Antorán B; Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain. bruizantoran@gmail.com.
  • Sancho-López A; Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain.
  • Torres F; Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute, Hospital Clinic, Barcelona, Spain.
  • Moreno-Torres V; Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
  • de Pablo-López I; Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain.
  • García-López P; Clinical Pharmacology Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
  • Abad-Santos F; Pneumology Department, Hospital Universitario Torrecardenas, Almería, Spain.
  • Rosso-Fernández CM; Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria la Princesa (IP), Madrid, Spain.
  • Aldea-Perona A; Unit of Clinical Pharmacology, Unit of Clinical Investigation and Clinical Trials, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
  • Montané E; Clinical Pharmacology Department, Consorcio Parc Salut MarInstituto Hospital del Mar de Investigaciones Médicas (IMIM)Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
  • Aparicio-Hernández RM; Clinical Pharmacology Department, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
  • Llop-Rius R; Department of Pharmacology, Therapeutics and Toxicology, Barcelona, Spain.
  • Pedrós C; Clinical Pharmacology Department, Hospital Universitario Central de La Defensa Gómez Ulla, Madrid, Spain.
  • Gijón P; Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
  • Hernández-Carballo C; Clinical Pharmacology Unit, Consorci Hospital General Universitari de València, Valencia, Spain.
  • Pedrosa-Martínez MJ; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
  • Rodríguez-Jiménez C; Internal Medicine Department, Hospital Universitario Nuestra Señora Candelaria, Tenerife, Spain.
  • Prada-Ramallal G; Clinical Pharmacology Department, Hospital Universitario Puerto Real, Cádiz, Spain.
  • Cabrera-García L; Clinical Pharmacology Department, Hospital Universitario de Canarias, Tenerife, Spain.
  • Aguilar-García JA; Departamento de Medicina Física y Farmacología, Facultad de Medicina, Universidad de La Laguna (ULL), Tenerife, Spain.
  • Sanjuan-Jimenez R; Epidemiology, Statistics and Research Methodology Unit, Institute for Health Research Foundation (FIDIS), Santiago de Compostela, Spain.
  • Ortiz-Barraza EI; Clinical Pharmacology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
  • Sánchez-Chica E; Internal Medicine Department, Hospital Costa del Sol Marbella, Málaga, Spain.
  • Fernández-Cruz A; UICEC IBIMA, Plataforma SCReN, Málaga, Spain.
Infect Dis Ther ; 10(1): 347-362, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-959415
ABSTRACT

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.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Infect Dis Ther Year: 2021 Document Type: Article Affiliation country: S40121-020-00373-8

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Infect Dis Ther Year: 2021 Document Type: Article Affiliation country: S40121-020-00373-8