Effectiveness of Tocilizumab with and without Dexamethasone in Patients with Severe COVID-19: A Retrospective Study

Figures & data

Table 1 Baseline Characteristics of Patients Included in the Study

	TCZ	DEX	TCZ/DEX	No-TCZ/no-DEX	P
	N=59	N=169	N=125	N=107
Females/males (n, %)	27/32, 46/54	65/104, 39/61	47/78, 38/62	41/66, 38/62	0.73
Age, years (mean, SD)	63.4, 12.5	64.4, 14.9	64.4, 14.9	67.0, 15.0	0.24
BMI (mean, SD)	29.7, 5.2	29.1, 5.3	29.6, 5.2	29.7, 6.4	0.79
Accompanying diseases (n, %)	50, 84.7	144.0, 85.2	101, 80.8	91, 85.0	0.75
Remdesivir (n, %)	22, 37.3	71, 42.0	40, 32.0	42, 39.3	0.37
Heparin (n, %)	53, 89.8	143, 84.6	109, 87.2	83, 77.6	0.12
Convalescent plasma (n, %)	7, 11.9	40, 23.7	29, 23.2	11, 10.3	0.01
Low-flow oxygen (n, %)	54, 92.5	153, 90.5	117, 93.6	100, 93.5	0.74
High-flow oxygen (n, %)	5, 8.5	16, 9.5	8, 6.4	7, 6.5	0.74
SpO2, % (mean, SD)	85.4, 6.0	84.9, 6.5	84.3, 5.8	85.1, 5.5	0.34
CRP, mg/l (mean, SD)	129.6, 103.5	104.9, 72.4	142.3, 79.4	110.0, 77.3	<0.001
Procalcitonin, ng/mL (mean, SD)	0.3, 0.5	0.5, 2.1	0.7, 3.1	0.6, 2.0	0.02
WBC, /µl (mean, SD)	6108, 2819	7792, 3482	8441, 4136	7855, 5835	<0.001
Platelets, ×10^3/µl (mean, SD)	207, 86	228, 101	223, 85	224, 113	0.52
IL-6, pg/mL (mean, SD)	139, 239	71, 141	192, 253	77, 116	<0.001
d-dimers, ng/mL (mean, SD)	1360, 2418	3823, 14,745	2884, 7296	2841, 6477	0.21

Table 2 Treatment Effectiveness Among All Patients Included in the Study

	TCZ	DEX	TCZ/DEX	No-TCZ/no-DEX	DEX vs TCZ	TCZ/DEX vs TCZ	no-TCZ/no-DEX vs TCZ
	N=59 n (%)	N=169 n (%)	N=125 n (%)	N=107 n (%)	P, OR (±95% CI)
Death	4 (6.8)	39 (23.1)	28 (22.4)	21 (19.6)	0.006, 0.24 (0.08–0.71)	0.01, 0.25 (0.09–0.76)	0.04, 0.30 (0.10–0.91)
Mechanical ventilation	4 (6.8)	15 (8.9)	18 (14.4)	10 (9.3)	0.79, 0.75 (0.24–2.35)	0.15, 0.43 (0.14–1.34)	0.77, 0.70 (0.21–2.36)
Improvement on day 14	21 (35.6)	81 (47.9)	50 (40.0)	43 (40.2)	0.12, 0.60 (0.32–1.11)	0.62, 0.83 (0.43–1.57)	0.62, 0.82 (0.42–1.59)
Improvement on day 21	34 (57.6)	111 (65.7)	73 (58.4)	67 (62.6)	0.28, 0.71 (0.39–1.30)	1.00, 0.97 (0.52–1.81)	0.62, 0.82 (0.42–1.55)
Improvement on day 28	44 (74.6)	122 (72.2)	87 (69.6)	75 (70.1)	0.86, 1.13 (0.58–2.22)	0.60, 1.28 (0.63–2.58)	0.59, 1.25 (0.61–2.56)
Discharged on day 14	16 (27.1)	76 (45.0)	46 (36.8)	37 (34.6)	0.02, 0.45 (0.24–0.87)	0.24, 0.64 (0.32–1.26)	0.39, 0.70 (0.35–1.42)
Discharged on day 21	30 (50.8)	110 (65.1)	73 (58.4)	64 (59.8)	0.06, 0.55 (0.30–1.01)	0.35, 0.74 (0.40–1.37)	0.32, 0.69 (0.37–1.32)
Discharged on day 28	43 (72.9)	119 (70.4)	87 (69.6)	73 (68.2)	0.87, 1.13 (0.58–2.19)	0.73, 1.17 (0.59–2.34)	0.60, 1.25 (0.62–2.53)

Table 3 Treatment Effectiveness Among Patients with IL-6≥100pg/mL

	TCZ	DEX	TCZ/DEX	No-TCZ/no-DEX	DEX vs TCZ	TCZ/DEX vs TCZ	No-TCZ/no-DEX vs TCZ
	N=20 n (%)	N=29 n (%)	N=70 n (%)	N=22 n (%)	P, OR (±95% CI)
Death	1 (5.0)	15 (51.7)	16 (22.9)	10 (45.5)	<0.001, 0.05 (0.01–0.42)	0.11, 0.18 (0.02–1.43)	0.004, 0.06 (0.01–0.56)
Mechanical ventilation	0 (0)	9 (31.0)	10 (14.3)	5 (22.7)	0.007, 0.05 (0.01–0.97)	0.11, 0.14 (0.01–2.51)	0.05, 0.08 (0.01–1.50)
Improvement on day 14	6 (30.0)	3 (10.3)	25 (35.7)	3 (13.6)	0.13, 3.71 (0.80–17.2)	0.79, 0.77 (0.26–2.26)	0.27, 2.71 (0.58–12.8)
Improvement on day 21	12 (60.0)	8 (27.6)	41 (58.6)	7 (31.8)	0.04, 3.94 (1.17–13.2)	1.00, 1.06 (0.38–2.93)	0.12, 3.21 (0.91–11.4)
Improvement on day 28	15 (75.0)	11 (37.9)	49 (70.0)	10 (45.5)	0.02, 4.91 (1.39–17.3)	0.78, 1.29 (0.41–4.00)	0.07, 3.60 (0.97–13.4)
Discharged on day 14	4 (20.0)	3 (10.3)	24 (34.3)	2 (9.1)	0.42, 2.17 (0.43–10.9)	0.28, 0.48 (0.14–1.60)	0.40, 2.50 (0.40–15.4)
Discharged on day 21	10 (50.0)	8 (27.6)	41 (58.6)	7 (31.8)	0.14, 2.62 (0.79–8.69)	0.61, 0.71 (0.26–1.92)	0.34, 2.14 (0.61–7.51)
Discharged on day 28	14 (70.0%)	10 (34.5)	49 (70.0)	10 (45.5)	0.02, 4.43 (1.30–15.1)	1.00, 1.00 (0.34–2.96)	0.13, 2.80 (0.78–10.0)

Table 4 Treatment Effectiveness Among Patients with IL-6<100pg/mL

	TCZ	DEX	TCZ/DEX	No-TCZ/no-DEX	DEX vs TCZ	TCZ/DEX vs TCZ	No-TCZ/no-DEX vs TCZ
	N=39 n (%)	N=140 n (%)	N=55 n (%)	N=85 n (%)	P, OR (±95% CI)
Death	3 (7.7)	24 (17.1)	12 (21.8)	11 (12.9)	0.21, 0.40 (0.11–1.41)	0.09, 0.30 (0.08–1.14)	0.54, 0.56 (0.15–2.14)
Mechanical ventilation	4 (10.3)	6 (4.3)	8 (14.5)	5 (5.9)	0.23, 2.55 (0.68–9.54)	0.75, 0.67 (0.18–2.41)	0.46, 1.83 (0.46–7.22)
Improvement on day 14	15 (38.5)	78 (55.7)	25 (45.5)	40 (47.1)	0.07, 0.50 (0.24–1.03)	0.53, 0.75 (0.32–1.73)	0.44, 0.70 (0.32–1.52)
Improvement on day 21	22 (56.4)	103 (73.6)	32 (58.2)	60 (70.6)	0.05, 0.46 (0.22–0.97)	1.00, 0.93 (0.41–2.13)	0.15, 0.54 (0.25–1.18)
Improvement on day 28	29 (74.4)	111 (79.3)	38 (69.1)	65 (76.5)	0.51, 0.76 (0.33–1.73)	0.65, 1.30 (0.52–3.25)	0.82, 0.89 (0.37–2.14)
Discharged on day 14	12 (30.8)	73 (52.1)	22 (40.0)	35 (41.2)	0.02, 0.41 (0.19–0.87)	0.39, 0.67 (0.28–1.59)	0.32, 0.63 (0.28–1.42)
Discharged on day 21	20 (51.3)	102 (72.9)	32 (58.2)	57 (67.1)	0.02, 0.39 (0.19–0.81)	0.53, 0.76 (0.33–1.73)	0.11, 0.52 (0.24–1.21)
discharged on day 28	29 (74.4)	109 (77.9)	38 (69.1)	63 (74.1)	0.67, 0.82 (0.36–1.88)	0.65, 1.30 (0.52–3.25)	1.00, 1.01 (0.42–2.41)

Figure 1 Kaplan–Meier plots of patients survival in particular arms by Log rank Mantel–Cox test supported by the Mantel–Haenszel hazard ratio (HR) and its 95% confidence interval.