Yonsei Med J
. 2022 May;63(5):430-439.
doi: 10.3349/ymj.2022.63.5.430.
Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19
Jin Yeong Hong # 1 , Jae-Hoon Ko # 1 , Jinyoung Yang 1 , Soyoung Ha 1 , Eliel Nham 1 , Kyungmin Huh 1 , Sun Young Cho 1 , Cheol-In Kang 1 , Doo Ryeon Chung 1 , Jin Yang Baek 2 , You Min Sohn 3 , Hyo Jung Park 3 , Beomki Lee 4 , Hee Jae Huh 4 , Eun-Suk Kang 4 , Gee Young Suh 5 , Chi Ryang Chung 6 , Kyong Ran Peck 7
Affiliations
- PMID: 35512745
- DOI: 10.3349/ymj.2022.63.5.430
Abstract
Purpose: Real-world experience with tocilizumab in combination with dexamethasone in patients with severe coronavirus disease (COVID-19) needs to be investigated.
Materials and methods: A retrospective cohort study was conducted to evaluate the effect of severity-adjusted dosing of dexamethasone in combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was 30-day clinical recovery, which was defined as no oxygen requirement or referral after recovery.
Results: A total of 66 patients were evaluated, including 33 patients in the dexamethasone (Dexa) group and 33 patients in the dexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinical recovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decrease in FiO2 (-4.2±2.6) than the Dexa group (-2.7±2.6; p=0.021) by hospital day 15. The duration of oxygen requirement was significantly shorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days; p=0.006). Infectious complications and cellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescence stage were not different between the two groups.
Conclusion: A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improved clinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.
Keywords: COVID-19; Dexamethasone; immune response; tocilizumab.