Author: Ruiz-Antoran, B.; Sancho-Lopez, A.; Torres, F.; Moreno-Torres, V.; de Pablo Lopez de Abechuco, I.; Garcia Lopez, P.; Abad-Santos, F.; Rosso Fernandez, C. M.; Aldea-Perona, A.; Montane, E.; Aparicio-Hernandez, R. M.; LLop Rius, R.; Pedros, C.; Gijon, P.; Hernandez Carballo, C.; Pedrosa Martinez, M. J.; Prada-Ramallal, G.; Cabrera Garcia, L.; Aguilar Garcia, J. A.; Sanjuan-Jimenez, R.; Ortiz Barraza, E. I.; Sanchez Chica, E.; Fernandez-Cruz, A.; group., TOCICOV-study
Title: COMBINATION OF TOCILIZUMAB AND STEROIDS TO IMPROVE MORTALITY IN PATIENTS WITH SEVERE COVID-19 INFECTION: A SPANISH, MULTICENTER, COHORT STUDY Cord-id: wt99wz6t Document date: 2020_9_9
ID: wt99wz6t
Snippet: Background: We aimed to determine the impact of tocilizumab use in severe COVID-19 pneumonia mortality. Methods: We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain, from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by Inverse Probability of the Treatment Weights (IPTW). Tocilizumab effect in patients receiving steroids during the 48h following
Document: Background: We aimed to determine the impact of tocilizumab use in severe COVID-19 pneumonia mortality. Methods: We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain, from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by Inverse Probability of the Treatment Weights (IPTW). Tocilizumab effect in patients receiving steroids during the 48h following inclusion was analyzed. Results: During the study period, 506 patients with severe COVID-19 fulfilled inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days (IQR 8-14). Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls (16.8% versus 31.5%, HR 0.514 [95CI 0.355-0.744], p<0.001; weighted HR 0.741 [95CI 0.619-0.887], p=0.001). Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment (RRR 46.7%). We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in patients treated with tocilizumab than in those treated with steroids alone (10.9% versus 40.2%, HR 0.511 [95CI 0.352-0.741], p=0.036; weighted HR 0.6 [95CI 0.449-0.804], p<0.001) (Interaction p=0.094). Conclusions: These results show that survival of patients with severe COVID-19 is higher in patients treated with tocilizumab than in those not treated, and that tocilizumab effect adds to that of steroids administered to non-intubated cases with COVID-19 during the first 48 hours of presenting with respiratory failure despite of oxygen therapy. Randomised controlled studies are needed to confirm these results.
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