• Francisco López-Medrano, María Asunción Pérez-Jacoiste Asín, Mario Fernández-Ruiz, Octavio Carretero, Antonio Lalueza, Guillermo Maestro de la Calle, José Manuel Caro, Cristina de la Calle, Mercedes Catalán, Rocío García-García, Joaquín Martínez-López, Julia Origüen, Mar Ripoll, San JuanRafaelRUnit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, School of Medicine, Univers, Hernando Trujillo, Ángel Sevillano, Eduardo Gutiérrez, Borja de Miguel, Fernando Aguilar, Carlos Gómez, José Tiago Silva, Daniel García-Ruiz de Morales, Miguel Saro-Buendía, Ángel Marrero-Sánchez, Guillermo Chiara-Graciani, Héctor Bueno, Estela Paz-Artal, Carlos Lumbreras, José L Pablos, José María Aguado, and H12O Immunomodulation Therapy for COVID-19 Group.
• Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain. Electronic address: flmedrano@yahoo.es.
• Int. J. Infect. Dis. 2021 Apr 1; 105: 487-494.

BackgroundThe role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear.MethodsA 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.ResultsTotals 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.ConclusionsThe combination of corticosteroids and TCZ was associated with better outcomes among patients aged ≥65 years with severe COVID-19.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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