Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: A single-center retrospective study

• Published in: International journal of infectious diseases Vol. 105; pp. 487 - 494
• Main Authors: López-Medrano, Francisco, Pérez-Jacoiste Asín, María Asunción, Fernández-Ruiz, Mario, Carretero, Octavio, Lalueza, Antonio, Maestro de la Calle, Guillermo, Caro, José Manuel, de la Calle, Cristina, Catalán, Mercedes, García-García, Rocío, Martínez-López, Joaquín, Origüen, Julia, Ripoll, Mar, San Juan, Rafael, Trujillo, Hernando, Sevillano, Ángel, Gutiérrez, Eduardo, de Miguel, Borja, Aguilar, Fernando, Gómez, Carlos, Silva, José Tiago, García-Ruiz de Morales, Daniel, Saro-Buendía, Miguel, Marrero-Sánchez, Ángel, Chiara-Graciani, Guillermo, Bueno, Héctor, Paz-Artal, Estela, Lumbreras, Carlos, Pablos, José L., Aguado, José María
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-04-2021; The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - administration & dosage; Corticosteroids; COVID-19; COVID-19 Drug Treatment; Drug Therapy, Combination; Female; Humans; Immunomodulation; Male; Methylprednisolone - administration & dosage; Middle Aged; Mortality; Outcome; Retrospective Studies; SARS-CoV-2; Therapy; Tocilizumab; COVID-19; Therapy; SARS-CoV-2; Corticosteroids; Tocilizumab; Immunomodulation; Outcome; Mortality
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2021.02.099

•An increasing number of immunomodulatory therapies are being tested for COVID-19.•A survival benefit has been shown with the use of corticosteroids.•The role of combination therapy with corticosteroids and tocilizumab is unclear.•This study analyzed a single-center cohort of patients aged ≥65 years with severe COVID-19.•The sequential use of corticosteroids and tocilizumab was associated with better outcomes.
The role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear.
A retrospective single-center study was conducted on consecutive patients aged ≥65 years who developed severe COVID-19 between 03 March and 01 May 2020 and were treated with corticosteroids at various doses (methylprednisolone 0.5mg/kg/12h to 250mg/24h), either alone (CS group) or associated with intravenous tocilizumab (400–600mg, one to three doses) (CS-TCZ group). The primary outcome was all-cause mortality by day +14, whereas secondary outcomes included mortality by day +28 and clinical improvement (discharge and/or a ≥2 point decrease on a 6-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied.
Totals of 181 and 80 patients were included in the CS and CS-TCZ groups, respectively. All-cause 14-day mortality was lower in the CS-TCZ group, both in the PS-adjusted (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.17–0.68; P=0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21–0.68; P=0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21–0.72; P=0.003). Clinical improvement by day +14 was higher in the CS-TCZ group with IPTW analysis only (OR: 2.26; 95% CI: 1.49–3.41; P<0.001). The occurrence of secondary infection was similar between both groups.
The combination of corticosteroids and TCZ was associated with better outcomes among patients aged ≥65 years with severe COVID-19.