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Pachón, Jerónimo; Carratalà, Jordi; Arribas, José Ramón; Gil Divasson, Pedro; Muñoz Aguirre, Clara; Arsuaga Vicente, Marta; Loeches Yagüe, Belén; Pérez-Latorre, Leire; Álvaro Alonso, Elena; Torres Macho, Juan; Brañas Baztán, Fátima; Muñiz Nicolás, Gemma; Sepúlveda Berrocal, Antonia; Toledano Sierra, María Pilar; Guio Carrión, Laura; Pérez Zapata, Inés; Kallouchi, Mohamed; Sanjuan López, Ainhoa; Suárez, Silvia; Ruiz Aragón, Jesús; Castilla Ortiz, Rosario; Alende Castro, Vanesa; Pérez García, Cristina; Villar-García, Judit; Vinuesa García, David; Martínez Montes, Clara; Ruiz Sancho, Andrés; Díaz de Brito Fernández, Vicens; Sanmarti Vilamala, Montserrat; Molina Morant, Daniel; Chara Cervantes, Joel Elías; Policarpo Torres, Guillem; De Genover Gil, Ariadna; Godoy Lorenzo, Rita; Ferrer Ribera, Ana; Oltra Sempere, Rosa; Fiorante, Silvana; Arnaiz de las Revillas, Francisco; Alonso Martínez, Blanca; Lidia Kamel Rey, Sara; Parra Ruiz, Jorge; Velasco Fuentes, Sara; García Pereña, Laura; Lluna Carrascosa, Alfonso; Gilaberte Reyzábal, Sergio; Liébana Gómez, Mónica; Rábago Lorite, Isabel; González-Ruano Pérez, Patricia; García Flores, Ángeles; Martín Plata, Andrea; Mohamed Ramírez, Karim; Castelo Corral, Laura; Rodríguez Mayo, María; Fernández Sánchez, Fernando; Hernández-Bonaga, María; Salamanca-Rivera, Elena; Gil Sánchez, Ricardo; Calzado Isbert, Sonia; Carrasco Antón, Nerea; Petkova-Saiz, Elizabet; Fernández Espinilla, Virginia; Ribot Sanso, María Antonia; Ortiz de Zárate Ibarra, Zuriñe; Saez de Adana Arroniz, Ester; del Amor Espín, Ma Jesús; Viqueira González, Montserrat; Martínez Madrid, Onofre; de la Rosa, Vicente; Caínzos Romero, Tamara; Álvarez Díaz, Hortensia; Valcarce Pardeiro, Nieves; Aguayo Jiménez, Carmen; Mora Delgado, Juan; Sevilla Moreno, Israel; Bustinduy Odriozola, María Jesús; Martínez Marcos, Francisco Javier; Muñoz Beamud, Francisco; Ruiz Reina, Antonio José; Llenas-García, Jara; Hellín-Valiente, Elena; Martínez Birlanga, Esther; Andrés Eisenhofer, Ane; Roger Zapata, Daniel; Garrido, Javier; Gonzalo, Concepción; de la Cruz Felipe, Nieves; Domingo Echaburu, Saioa; Cuadros Tito, Pedro Ángel; Roldán Fontana, Carolina; Herrero Rodríguez, Carmen; Hortos Alsina, Miquel; Cisneros, José Miguel; Aguilar-Guisado, Manuela; Vizcarra, Pilar; Martín Dávila, Pilar; García-García, Concepción; Santibañez Sáenz, Paula; Cervera Acedo, Cristina; Azcona Gutiérrez, José M.; Reguera Iglesias, José María
Clinical microbiology and infection, 02/2021, Letnik: 27, Številka: 2Journal Article
The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001). Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation. Display omitted
