Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective observational study (COQUIMA cohort)

Abstract

Background The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d -dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO 2 /FiO 2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p <0·001). Interpretation In a real-clinical setting, inhibition of the calcineurin inflammatory pathway, NF-κΒ, could reduce the hyperinflammatory phase in COVID-19. Our findings might entail relevant implications for the therapy of this disease and could boost the design of new clinical trials among subjects affected by severe COVID-19. Funding Hospital Universitario Quironsalud Madrid. Own fundings for COVID-19 research.

Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis, first update

“…In addition, we identified 10 additional cohort studies since our first review 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 . A total of 28 cohort studies, at moderate risk of bias, reported on adjusted effect estimates of mortality.…”

Drug repurposing screens reveal cell-type-specific entry pathways and FDA-approved drugs active against SARS-Cov-2

“…Excitingly, prospective trials using cyclosporin A have recently begun (ClinicalTrials.gov: NCT04412785). A retrospective observational study recently found that in hospitalized patients, among the prescribed therapies, including lopinavir/ritonavir and hydroxychloroquine, only cyclosporine was significantly associated with a decrease in mortality (Guisado-Vasco et al, 2020). Perhaps the combined activity of immunosuppression and antiviral activity led to these promising results.…”

Comorbidities increase the risk of severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…The second subgroup was composed of studies that evaluated hospitalized COVID-19 patients who recovered or died (39,722 died and 295,500 recovered) (Chen et al, 2020b;Chen et al, 2020c;Chen et al, 2020d;Deng et al, 2020;Guisado-Vasco et al, 2020;Javanian et al, 2020;Li et al, 2020c;Morrison et al, 2020;Ñamendys-Silva et al, 2020;Parra-Bracamonte et al, 2020;Shang et al, 2020;Vena et al, 2020;Yao et al, 2020;. The characteristics of the studies included in the meta-analysis are shown in Tables 1A and 1B.…”