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. 2020 Dec:101:290-297.
doi: 10.1016/j.ijid.2020.09.1486. Epub 2020 Oct 6.

Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

Manuel Rubio-Rivas  1 , Mar Ronda  2 , Ariadna Padulles  2 , Francesca Mitjavila  3 , Antoni Riera-Mestre  3 , Carlos García-Forero  4 , Adriana Iriarte  3 , Jose M Mora  3 , Nuria Padulles  2 , Monica Gonzalez  2 , Xavier Solanich  3 , Merce Gasa  5 , Guillermo Suarez-Cuartin  5 , Joan Sabater  6 , Xose L Perez-Fernandez  6 , Eugenia Santacana  2 , Elisabet Leiva  2 , Albert Ariza-Sole  7 , Paolo D Dallaglio  7 , Maria Quero  8 , Antonio Soriano  9 , Alberto Pasqualetto  10 , Maylin Koo  10 , Virginia Esteve  3 , Arnau Antoli  3 , Rafael Moreno-Gonzalez  3 , Sergi Yun  3 , Pau Cerda  3 , Mariona Llaberia  3 , Francesc Formiga  3 , Marta Fanlo  3 , Abelardo Montero  3 , David Chivite  3 , Olga Capdevila  3 , Ferran Bolao  3 , Xavier Pinto  3 , Josep Llop  2 , Antoni Sabate  10 , Jordi Guardiola  9 , Josep M Cruzado  8 , Josep Comin-Colet  7 , Salud Santos  5 , Ramon Jodar  2 , Xavier Corbella  11
Affiliations

Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

Manuel Rubio-Rivas et al. Int J Infect Dis. 2020 Dec.

Abstract

Objectives: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: COVID-19; Corticosteroids; Mortality; Systemic inflammation; Tocilizumab.

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