tetano
Editor, Senior Moderator
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[SUP] #[/SUP][SUP] 1 [/SUP], Jae-Hoon Ko[SUP] #[/SUP][SUP] 1 [/SUP], Jinyoung Yang[SUP] 1 [/SUP], Soyoung Ha[SUP] 1 [/SUP], Eliel Nham[SUP] 1 [/SUP], Kyungmin Huh[SUP] 1 [/SUP], Sun Young Cho[SUP] 1 [/SUP], Cheol-In Kang[SUP] 1 [/SUP], Doo Ryeon Chung[SUP] 1 [/SUP], Jin Yang Baek[SUP] 2 [/SUP], You Min Sohn[SUP] 3 [/SUP], Hyo Jung Park[SUP] 3 [/SUP], Beomki Lee[SUP] 4 [/SUP], Hee Jae Huh[SUP] 4 [/SUP], Eun-Suk Kang[SUP] 4 [/SUP], Gee Young Suh[SUP] 5 [/SUP], Chi Ryang Chung[SUP] 6 [/SUP], Kyong Ran Peck[SUP] 7 [/SUP]
Affiliations
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 FiO[SUB]2[/SUB] 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 FiO[SUB]2[/SUB] (-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.
. 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[SUP] #[/SUP][SUP] 1 [/SUP], Jae-Hoon Ko[SUP] #[/SUP][SUP] 1 [/SUP], Jinyoung Yang[SUP] 1 [/SUP], Soyoung Ha[SUP] 1 [/SUP], Eliel Nham[SUP] 1 [/SUP], Kyungmin Huh[SUP] 1 [/SUP], Sun Young Cho[SUP] 1 [/SUP], Cheol-In Kang[SUP] 1 [/SUP], Doo Ryeon Chung[SUP] 1 [/SUP], Jin Yang Baek[SUP] 2 [/SUP], You Min Sohn[SUP] 3 [/SUP], Hyo Jung Park[SUP] 3 [/SUP], Beomki Lee[SUP] 4 [/SUP], Hee Jae Huh[SUP] 4 [/SUP], Eun-Suk Kang[SUP] 4 [/SUP], Gee Young Suh[SUP] 5 [/SUP], Chi Ryang Chung[SUP] 6 [/SUP], Kyong Ran Peck[SUP] 7 [/SUP]
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 FiO[SUB]2[/SUB] 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 FiO[SUB]2[/SUB] (-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.