Beneficial Effect of Corticosteroids in Preventing Mortality in Patients Receiving Tocilizumab to Treat Severe COVID-19 Illness

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

OBJECTIVES: To assess the characteristics and risk factors for mortality in patients with severe 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 COVID-19 patients 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, 155 (83.3 %) patients were receiving non-invasive 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 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 severe COVID-19 patients receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed beneficial effect in preventing in-hospital mortality.