Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness.
Adrenal Cortex Hormones
/ administration & dosage
Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ administration & dosage
COVID-19
/ mortality
Drug Therapy, Combination
Female
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Retrospective Studies
SARS-CoV-2
/ drug effects
COVID-19 Drug Treatment
COVID-19
Corticosteroids
Mortality
Systemic inflammation
Tocilizumab
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
29
08
2020
revised:
26
09
2020
accepted:
30
09
2020
pubmed:
10
10
2020
medline:
23
12
2020
entrez:
9
10
2020
Statut:
ppublish
Résumé
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). 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. 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. 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.
Identifiants
pubmed: 33035673
pii: S1201-9712(20)32202-5
doi: 10.1016/j.ijid.2020.09.1486
pmc: PMC7537652
pii:
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Antibodies, Monoclonal, Humanized
0
tocilizumab
I031V2H011
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
290-297Informations de copyright
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Références
Chest. 2007 Aug;132(2):410-7
pubmed: 17573487
Int J Antimicrob Agents. 2020 May;55(5):105954
pubmed: 32234467
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
EClinicalMedicine. 2020 Jun 20;24:100418
pubmed: 32766537
Front Med (Lausanne). 2020 Oct 02;7:586221
pubmed: 33123544
Proc Natl Acad Sci U S A. 2020 May 19;117(20):10970-10975
pubmed: 32350134
J Heart Lung Transplant. 2020 May;39(5):405-407
pubmed: 32362390
N Engl J Med. 2020 Jun 11;382(24):2327-2336
pubmed: 32275812
Eur Respir J. 2020 May 7;55(5):
pubmed: 32269088
Int J Antimicrob Agents. 2020 Jul;56(1):105949
pubmed: 32205204
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
N Engl J Med. 2020 May 7;382(19):1787-1799
pubmed: 32187464
J Autoimmun. 2020 Nov;114:102511
pubmed: 32713677
BMJ. 2020 Mar 26;368:m1252
pubmed: 32217607
J Med Virol. 2020 Oct;92(10):1787-1788
pubmed: 32297987
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
PLoS One. 2020 Aug 20;15(8):e0237831
pubmed: 32817707
Int J Antimicrob Agents. 2020 Sep;56(3):106103
pubmed: 32712333
Pharmaceuticals (Basel). 2020 Oct 17;13(10):
pubmed: 33080877
J Med Virol. 2020 Nov;92(11):2283-2285
pubmed: 32343429
J Clin Virol. 2020 Aug;129:104444
pubmed: 32570043
J Med Virol. 2021 Jan;93(1):463-471
pubmed: 32720702
JAMA. 2020 May 12;323(18):1824-1836
pubmed: 32282022
QJM. 2020 Aug 1;113(8):546-550
pubmed: 32569363
Chest. 2020 Oct;158(4):1397-1408
pubmed: 32553536