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Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study
- Source :
- International Journal of Infectious Diseases, International Journal of Infectious Diseases, Vol 105, Iss, Pp 487-494 (2021)
- Publication Year :
- 2021
- Publisher :
- Published by Elsevier Ltd on behalf of International Society for Infectious Diseases., 2021.
-
Abstract
- BackgroundThe role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear.MethodsWe conducted a retrospective single-center study including consecutive patients ≥65 years that developed severe COVID-19 between March 3 and May 1, 2020 and were treated with corticosteroids at various doses (methylprednisolone [0.5 mg/Kg/12 hours to 250 mg/24 hours]), either alone (“CS group”) or associated to intravenous tocilizumab (400-600 mg, one to three doses) (“CS-TCZ group”). 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 six-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied.ResultsOverall, 181 and 80 patients were included in the CS and CS-TCZ groups. 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-value = 0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21 – 0.68;P-value = 0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21 – 0.72;P-value = 0.003). Clinical improvement by day +14 was higher in the CS-TCZ group in the IPTW analysis only (OR: 2.26; 95% CI: 1.49 – 3.41;P-value ConclusionsThe combination of corticosteroids and TCZ was associated with better outcomes among patients ≥65 years with severe COVID-19.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Male
medicine.medical_specialty
Combination therapy
Secondary infection
030106 microbiology
Infectious and parasitic diseases
RC109-216
Single Center
immunomodulation
Antibodies, Monoclonal, Humanized
Gastroenterology
Methylprednisolone
Article
corticosteroids
03 medical and health sciences
chemistry.chemical_compound
tocilizumab
0302 clinical medicine
Tocilizumab
Internal medicine
medicine
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Aged, 80 and over
therapy
business.industry
SARS-CoV-2
Hazard ratio
COVID-19
Retrospective cohort study
General Medicine
Odds ratio
Middle Aged
mortality
Confidence interval
COVID-19 Drug Treatment
Infectious Diseases
chemistry
outcome
Drug Therapy, Combination
Female
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 18783511 and 12019712
- Database :
- OpenAIRE
- Journal :
- International Journal of Infectious Diseases
- Accession number :
- edsair.doi.dedup.....9367fb4987a74fb0558b279391bdf7c1