Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab

Abstract

Tocilizumab (TCZ) and Dexamethasone are used for the treatment of critically ill COVID-19 patients. We compared the short-term survival of critically ill COVID-19 patients treated with either TCZ or Dexamethasone. 109 critically ill COVID-19 patients randomly assigned to either TCZ therapy (46 patients) or pulse Dexamethasone therapy (63 patients). Age, sex, neutrophil/ lymphocyte ratio, D-dimer, ferritin level, and CT chest pattern were comparable between groups. Kaplan–Meier survival analysis showed better survival in Dexamethasone group compared with TCZ (P = 0.002), patients didn’t need vasopressor at admission (P < 0.0001), patients on non-invasive ventilation compared to patients on mechanical ventilation (P<0.0001 ), and in patients with ground glass pattern in CT chest (P<0.0001 ) compared with those who have consolidation. Cox regression analysis showed that, TCZ therapy (HR = 2.162, 95% CI, 1.144–4.087, P <0.0001) compared with Dexamethasone group, higher neutrophil/Lymphocyte ratio (HR = 2.40, CI, 1.351–4.185, P = 0.003), lower PaO2/FiO2, 2 days after treatment, (HR = 1.147, 95% CI, 1.002–1.624, P < 0.0001) independently predicted higher probability of mortality. Dexamethasone showed better survival in severe COVID-19 compared to TCZ. Considering the risk factors mentioned here is crucial when dealing with severe COVID-19 cases.Clinical trial registration No clinicalTrials.gov: Nal protocol approved by Hospital Authorities, for data collection and for participation in CT04519385 (19/08/2020).

Efficacy and safety of IL-6 inhibitors in patients with COVID-19 pneumonia: a systematic review and meta-analysis of multicentre, randomized trials

“…After initial screening, a total of 22 studies were retrieved as complete articles. After exclusion of three non-randomized trials [ 28 – 30 ], three study protocols [ 31 – 33 ], and one study comparing tocilizumab against dexamethasone [ 34 ], a total of 15 studies randomizing 9320 patients were included in the analysis (Fig. 1 ) [ 35 – 49 ].…”

“…Three studies have not yet undergone peer-review as of September 15th 2021 and are available as pre-print only [ 42 , 44 , 47 ]. One study was performed on ICU patients alone [ 48 ], and eight studies also included patients under invasive mechanical ventilation at baseline [ 34 , 40 , 41 , 43 , 45 – 48 ] (Table 2 ). Concomitant use of steroids was highly variable across studies, ranging from 10.6 to 91.1% of enrolled patients (Table 2 ).…”

Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials

“…Eight randomised trials 4 , 19 , 20 , 21 , 22 , 23 , 24 , 25 were multi-centre, with RECOVERY [4] contributing 80% of all patients to the meta-analysis. The remaining trials 26 , 27 , 28 were conducted in single sites in Iran, Brazil, and Egypt.…”

The role of integrated programs in the prevention of COVID-19 in a humanitarian setting

“… 2 Appropriate supportive care and strict prevention/control strategies are recommended, plus using one of the suggested treatments, such as dexamethasone or tocilizumab. 3 SARS-CoV-2 transmits via respiratory droplets from infected people. 2 This mode of transmission raises concerns, particularly in densely populated areas like humanitarian camps.…”