Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness
Manuel Rubio‐Rivas, Mar Ronda, Ariadna Padullés, Francesca Mitjavila, Antoni Riera‐Mestre, Carlos G. Forero, Adriana Iriarte, José María Mora, Núria Padullés Zamora, Mònica González, Xavier Solanich, Mercè Gasa, Guillermo Suárez-Cuartín, Joan Sabater‐Riera, Xosé Pérez-Fernández, E Santacana, E. Leiva Badosa, Albert Ariza‐Solé, Paolo Dallaglio, María Quero, Antonio Soriano, Alberto Pasqualetto, Maylin Koo, Virginia Esteve-Luque, Arnau Antolí, Rafael Moreno‐González, Sergi Yun, Pau Cerdà, Mariona Llaberia, Francesç Formiga, Marta Fanlo‐Maresma, Abelardo Montero, David Chivite, Olga Capdevila, Ferrán Bolao, Xavier Pintó, Josep Llop, A. Sabaté, Jordi Guardiola, Josep M. Cruzado, Josep Comín‐Colet, Salud Santos, R. Jódar, Xavier Corbella
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.