• Clin. Microbiol. Infect. · Feb 2021

    Multicenter Study

    Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19).

    • Jesús Rodríguez-Baño, Jerónimo Pachón, Jordi Carratalà, Pablo Ryan, Inmaculada Jarrín, María Yllescas, José Ramón Arribas, Juan Berenguer, SAM-COVID Study Group, Fundación SEIMC-GESIDA, Hospital Universitario La Paz, Hospital Universitario Gregorio Marañón, Hospital Infanta Leonor, Complejo Hospitalario Virgen de la Salud, Hospital Universitario Rafael Méndez, Hospital Universitario de Cruces, Hospital de Melilla, Hospital San Eloy de Barakaldo, Hospital Universitario Central de Asturias, Hospital Universitario Puerto Real, Hospital do Salnés, Hospital del Mar, Hospital Virgen de la Arrixaca, Hospital Clínico San Cecilio, Parc Sanitari Sant Joan de Déu, Hospital Josep Trueta, Hospital Dos De Maig - Consorci Sanitari Integral, Hospital Clínico Universitario de Valencia, Complejo Asistencial de Ávila, Hospital Universitario Marqués de Valdecilla, Hospital de Barcelona SCIAS, Hospital Álvaro Cunqueiro, Hospital Universitario Severo Ochoa, Hospital CIMA-Sanitas, Hospital La Inmaculada, Hospital de Guadalajara, Hospital Universitario Infanta Sofia, Hospital Comarcal de Blanes, Hospital Universitario de Gran Canaria Dr Negrín, Hospital Son Espases, Complejo Hospitalario Universitario A Coruña, Hospital Costa del Sol, Hospital Clínico Universitario Lozano Blesa, Hospital Mutua de Terrassa, Hospital Universitario Virgen Macarena, Hospital Universitari de Bellvitge, Hospital Universitario y Politécnico La Fe, Hospital de Sabadell (Parc Tauli), Hospital Fundación Jiménez Díaz, Hospital Clínico Universitario de Valladolid, Hospital Son Llatzer, Hospital Universitario de Álava, Complejo Hospitalario Universitario Santa Lucía, Hospital General Universitario Reina Sofía, Complejo Hospitalario Universitario de Ferrol, Hospital Universitario los Arcos del Mar Menor, Hospital Universitario de Jerez, Hospital de Donostia, Hospital Juan Ramón Jiménez, Hospital Vega Baja, Hospital Puerta de Hierro, Hospital Universitario de Getafe, Hospital General de la Palma, Fundación Hospital de Calahorra, Hospital Alto Deba, Hospital Universitario de Jaén, Hospital de Palamós, Hospital Universitario de Valme, Hospital Universitario Virgen del Rocío, Hospital Universitario Ramón y Cajal, Hospital Universitario San Pedro, and Hospital Regional de Málaga.
    • Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. Electronic address: jesusrb@us.es.
    • Clin. Microbiol. Infect. 2021 Feb 1; 27 (2): 244-252.

    ObjectivesThe objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters.MethodsA cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).ResultsIn all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001).ConclusionsTocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…