Tocilizumab and steroid treatment in patients with COVID-19 pneumonia

Abstract

Introduction Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome. Methods This observational single-center study included patients with COVID-19 pneumonia who were not intubated and received either standard of care (SOC, controls) or SOC plus early (within 3 days from hospital admission) anti-inflammatory treatment. SOC consisted of hydroxychloroquine 400mg bid plus, in those admitted before March 24 th , also darunavir/ ritonavir. Anti-inflammatory treatment consisted of either tocilizumab (8mg/kg intravenously or 162mg subcutaneously) or methylprednisolone 1 mg/kg for 5 days or both. Failure was defined as intubation or death, and the endpoints were failure-free survival

Beneficial Effect of Corticosteroids in Preventing Mortality in Patients Receiving Tocilizumab to Treat Severe COVID-19 Illness

“…In this regard, recent real-world observational studies of high quality from Italy, Spain, France and the US, indicated that TCZ might reduce ICU admissions, mechanical ventilator use, and risk of death, when compared to control group only treated with SOC [15][16][17][18][19][20][21][22][23][24]. Moreover, Moreno-García et al [16] conclude that the beneficial effect of TCZ might be especially shown in the subset of severely-ill non-intubated COVID-19 patients at early stage of the systemic hyperinflammatory response.…”

“…Nowadays, there is an emerging number of additional observational studies of higher quality from Italy, Spain, France and the US, either recently published or registered in the medRxiv repository [15][16][17][18][19][20][21][22][23][24]. These studies mostly assessed the use of TCZ in the subset of severely-ill non-intubated COVID-19 patients and were compared to a control group.…”

Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications

“…24–26 COVID-19 patients are considered to have severe pneumonia, which may require a ventilator if they are experiencing respiratory distress (≥30 breaths per min); oxygen saturation at rest (≤93%); a ratio of the partial pressure of arterial oxygen to fractional oxygen concentration (paO 2 /fiO 2 ) ≤300 mm hg; or having severe complications such as organ failures. 27 , 28 Lung inflammation, an essential symptom of severe pneumonia, occurs with baseline fever (>38°C), C-reactive protein (10 times than usual 5 mg/dl), ferritin (2 times of 400 µg/l), or IL-6 (10 times than 3.4 mg/l). 27 , 28 The goal of managing patients with COVID-19 infection is to reduce the viral load, improve lung function, treat any fever, control diarrhea, and improve the body’s immune system, known as the standard of care (SOC).…”

“… 27 , 28 Lung inflammation, an essential symptom of severe pneumonia, occurs with baseline fever (>38°C), C-reactive protein (10 times than usual 5 mg/dl), ferritin (2 times of 400 µg/l), or IL-6 (10 times than 3.4 mg/l). 27 , 28 The goal of managing patients with COVID-19 infection is to reduce the viral load, improve lung function, treat any fever, control diarrhea, and improve the body’s immune system, known as the standard of care (SOC). 27 , 28 Some medicines that have been prescribed for patients with COVID-19 include antiviral agents (lopinavir 40 mg/ritonavir 100 mg twice a day or remdesivir 100 mg/day), antibiotics including azithromycin (500mg daily) and ceftriaxone (1g daily), antimalarials, including hydroxychloroquine (600mg daily), zinc sulfate (20mg daily), dexamethasone (6mg/day), and vitamin C (3g daily).…”

“… 27 , 28 Some medicines that have been prescribed for patients with COVID-19 include antiviral agents (lopinavir 40 mg/ritonavir 100 mg twice a day or remdesivir 100 mg/day), antibiotics including azithromycin (500mg daily) and ceftriaxone (1g daily), antimalarials, including hydroxychloroquine (600mg daily), zinc sulfate (20mg daily), dexamethasone (6mg/day), and vitamin C (3g daily). 27 , 29–38 …”