Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

López‐Medrano, Francisco; Asín, María Asunción Pérez‐Jacoiste; Fernández‐Ruiz, Mario; Carretero, Octavio; Lalueza, Antonio; Manuel, José; Calle, C. de la; Catalán, M.; García-García, Rocío; Martínez‐López, Joaquín; Origüen, Julia; Ripoll, M.; Juan, Rafael San; Trujillo, Hernando; Sevillano, Ángel; Gutiérrez, Eduardo; Miguel, Borja de; Aguilar, Fernando J.; Gómez, Carlos; Silva, José Tiago; Morales, Daniel; Saro-Buendía, Miguel; Marrero-Sánchez, Ángel; Chiara-Graciani, Guillermo; Bueno, Héctor; Paz‐Artal, Estela; Lumbreras, Carlos; Pablos, José L.; Aguado, José María

doi:10.1101/2020.09.26.20202283

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…A cohort study by Narain et al shows that the combination of corticosteroids and tocilizumab for the treatment of patients increase patient survival when compared with the control group or the group receiving corticosteroids alone 29 . Another observational study showed that combination treatment with steroids and tocilizumab had better results than when steroids were added at a later stage 30 . On the other hand Rodríguez–Bano showed that mortality rates were higher in patients receiving a combination of corticosteroids and tocilizumab compared to those that received only tocilizumab.…”

Section: Discussionmentioning

confidence: 99%

“…29 Another observational study showed that combination treatment with steroids and tocilizumab had better results than when steroids were added at a later stage. 30 On the other hand Rodríguez-Bano showed that mortality rates were higher in patients receiving a combination of corticosteroids and tocilizumab compared to those that received only tocilizumab. This could be due to different times and different doses of drugs.…”

Section: Discussionmentioning

confidence: 99%

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Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Moosazadeh

Mousavi

2021

Journal of Medical Virology

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BackgroundThe coagulation markers, pro-in ammatory cytokines (such as IL-2R, IL-6, IL-10, and TNF-a) and Lymphopenia are associated with the severity of COVID-19 disease. The use of anti-in ammatory agents such as corticosteroids (CS) or Tosilizumab (TCZ) has been suggested for the treatment of advanced stage of COVID-19 and reduction of mechanical ventilators and mortality. The aim of this meta-analysis is to determine the role of combination therapy with Tocilizumab and steroid in COVID-19 patient. Material and methodsRelevant studies were found using online international databases and suitable studies were selected and assessed by two independent researchers. The quality of all papers were determined by a checklist. Heterogeneity assay among the primary studies was evaluated by Cochran's Q test and I2 index. The statistical analyses were done using Stata ver. 14 package (StataCorp, College Station, TX, USA) software. Publication bias was estimated through the Egger's test and the impact of each study on the overall estimate was assessed by sensitivity analysis. Result 6 studies were entered into this meta-analysis. The results of these studies showed that the risk of death for COVID-19 patients treated with the combination of corticosteroids and Tocilizumab compared to Tocilizumab or [C1] control group was 0.74 (95% CI: 0.36-1.50) and 0.48(95% CI: 0.31-0.74) respectively. ConclusionThis meta-analysis showed that the risk of death in COVID-19 patients who treated with Corticosteroids and Tocilizumab was lower than Tocilizumab and control group (26% and 52% respectively).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Moosazadeh

Mousavi

2021

Journal of Medical Virology

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“…The PRISMA flow diagram is detailed in Figure 1. The majority of included studies were carried out in different hospitals from countries in America and Europe, such as the United States (US) 46,47,[51][52][53][54][55]61,67,68,70,76,82,84,[86][87][88][89][90]92,94 , Italy (ITA) 41,[43][44][45]48,49,58,60,69,77,79,91,95 , Spain (SPA) 40,42,63,64,71,75,78,83,85 , and France (FRA). 56,57,59,62,96 A lesser number was conducted in Sweden (SWE) 50 , India (IND)…”

Section: Re Sultsmentioning

confidence: 99%

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

et al. 2021

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Introduction:The results of studies of tocilizumab (TCZ) in COVID-19 are contradictory. Our study aims to update medical evidence from controlled observational studies and randomized clinical trials (RCTs) on the use of TCZ in hospitalized patients with COVID-19. Methods:We searched the following databases from January 1, 2020 to April 13, 2021 (date of the last search): MEDLINE database through the PubMed search engine and Scopus, using the terms ("COVID-19" [Supplementary Concept]) AND "tocilizumab" [Supplementary Concept]).Results: Sixty four studies were included in the present study: 54 were controlled observational studies (50 retrospective and 4 prospective) and 10 were RCTs. The overall results provided data from 20,616 hospitalized patients with COVID-19: 7668 patients received TCZ in addition to standard of care (SOC) (including 1915 patients admitted to intensive care units (ICU) with reported mortality) and 12,948 patients only receiving SOC (including 4410 patients admitted to the ICU with reported mortality). After applying the random-effects model, the hospital-wide (including ICU) pooled mortality odds ratio (OR) of patients with COVID-19 treated with TCZ was 0.73 (95% confidence interval (CI) = 0.56-0.93). The pooled hospital-wide mortality OR was 1.25 (95% CI = 0.74-2.18) in patients admitted at conventional wards versus 0.66 (95% CI = 0.59-0.76) in patients admitted to the ICU. The pooled OR of hospitalwide mortality (including ICU) of COVID-19 patients treated with TCZ plus corticosteroids (CS) was 0.67 (95% CI = 0.54-0.84). The pooled in-hospital mortality OR was 0.71 (95% CI = 0.35-1.42) when TCZ was early administered (≤10 days from symptom onset) versus 0.83 (95% CI 0.48-1.45) for late administration (>10 days from symptom onset). The meta-analysis did not find significantly higher risk for secondary infections in COVID-19 patients treated with TCZ.Conclusions: TCZ prevented mortality in patients hospitalized for COVID-19. This benefit was seen to a greater extent in patients receiving concomitant CS and when TCZ administration occurred within the first 10 days after symptom onset.

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“…The current WHO recommendation concerns their use in severe or critical forms of the disease, in patients requiring oxygen (50), as they reduce mortality to approximately one third of the mechanically ventilated patients and to one fifth in those requiring oxygen, and can be used in pregnant women with severe forms, under the form of orally administered prednisone or intravenous hydrocortisone hemisuccinate (51). Combination therapy with tocilizumab in patients aged 65 or more with enhanced inflammatory syndrome proved beneficial for recovery (52). The use of corticosteroids in severe forms of the disease has demonstrated a clinical benefit, without any differences when the dose administered was smaller or larger, as well as the fact that smaller doses do not impact the viral replication (53).…”

Section: Corticosteroidsmentioning

confidence: 99%

Options of Treatment in SARS-CoV-2 Infections

2021

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Starting December 2019, in China, the SARS-CoV-2 infection became a local health issue, but its high infectiveness quickly turned it into a pandemic, to be declared an epidemiological emergency of international concern less than two months from identifying the first cases. Despite tremendous efforts aimed at discovering new drug classes that would slow down or stop the evolution of the COVID-19 disease and curb the number of severe cases and related complications, there is no specific antiviral treatment to date. The only efficient measure proved to be the prophylaxis, through vaccination.

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Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

Cited by 6 publications

References 27 publications

Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Beneficial and harmful outcomes of tocilizumab in severe COVID‐19: A systematic review and meta‐analysis

Options of Treatment in SARS-CoV-2 Infections

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