https://orcid.org/0000-0003-0938-1084
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Abstract
Purpose
The pathogenesis of coronavirus disease 2019 (COVID-19) is complicated, and in addition to antiviral therapy and combating coagulopathy, treatment should also include inhibition of the proinflammatory cytokines overproduction. The purpose of this study is to compare the effectiveness of tocilizumab (TCZ) and dexamethasone (DEX) administered alone or in combination in patients with severe COVID-19.
Patients and Methods
Patients were selected from the SARSTer database, containing 3330 individuals with COVID-19 treated between 1 March 2020 and 10 March 2021. The current study included adult patients with baseline oxygen saturation (SpO2) ≤90%, requiring regular or non-invasive high-flow oxygen supplementation.
Results
Among included 460 patients, 59 were treated with TCZ, 125 with TCZ and DEX, 169 with DEX, and 107 did not receive TCZ nor DEX. The groups were balanced regarding demographics, coexisting diseases, baseline SpO2, and comedications with remdesivir or low-molecular-weight heparin. The death rate of 6.8% was significantly lower in patients receiving TCZ alone than each arm (19.6%–23.1%), particularly in patients with interleukin-6 concentration exceeding 100pg/mL (5% vs 22.9%–51.7%, respectively). Analysis of clinical improvement demonstrated doubled, significantly higher rate after 21 and 28 days in patients treated with TCZ alone (60% and 75%, respectively) compared to DEX (27.6% and 37.9%, respectively). The need for mechanical ventilation was similar in all arms.
Conclusion
In patients with severe course of COVID-19, particularly those developing cytokine storm, administration of TCZ provides a significantly better effect than DEX regarding survival, clinical improvement, and hospital discharge rate. The combination of TCZ and DEX does not improve therapy effectiveness in patients with severe COVID-19 compared to the administration of TCZ alone.
Data Sharing Statement
The original anonymous dataset is available on request from the corresponding author at [email protected].
Disclosure
Dr Dorota Zarębska-Michaluk reports grants from Agencja Badań Medycznych, during the conduct of the study; personal fees from Gilead, personal fees from AbbVie, outside the submitted work. Dr Jerzy Jaroszewicz reports grants, non-financial support from Gilead, personal fees, non-financial support from Roche, personal fees from Bausch Health, outside the submitted work. Professor Robert Flisiak reports grants, personal fees from Roche, during the conduct of the study; grants, personal fees from Gilead, grants, personal fees from AbbVie, grants, personal fees from MSD, personal fees from Adamed, personal fees from Pfizer, outside the submitted work. The authors declare no other competing interests in this work.