Tocilizumab and steroid treatment in patients with COVID-19 pneumonia
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...
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| creator | Mikulska, Malgorzata Nicolini, Laura Ambra Signori, Alessio Di Biagio, Antonio Sepulcri, Chiara Russo, Chiara Dettori, Silvia Berruti, Marco Sormani, Maria Pia Giacobbe, Daniele Roberto Vena, Antonio De Maria, Andrea Dentone, Chiara Taramasso, Lucia Mirabella, Michele Magnasco, Laura Mora, Sara Delfino, Emanuele Toscanini, Federica Balletto, Elisa Alessandrini, Anna Ida Baldi, Federico Briano, Federica Camera, Marco Dodi, Ferdinando Ferrazin, Antonio Labate, Laura Mazzarello, Giovanni Pincino, Rachele Portunato, Federica Tutino, Stefania Barisione, Emanuela Bruzzone, Bianca Orsi, Andrea Schenone, Eva Rosseti, Nirmala Sasso, Elisabetta Da Rin, Giorgio Pelosi, Paolo Beltramini, Sabrina Giacomini, Mauro Icardi, Giancarlo Gratarola, Angelo Bassetti, Matteo |
| description | 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. 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.sup.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 (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HR.sub.OW). Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO.sub.2 /FiO.sub.2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HR.sub.OW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HR.sub.OW 0.41, 95%CI: 0.19-0.89, p = 0.025. Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia. |
| doi_str_mv | 10.1371/journal.pone.0237831 |
| format | Article |
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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. 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.sup.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 (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HR.sub.OW). Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO.sub.2 /FiO.sub.2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HR.sub.OW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HR.sub.OW 0.41, 95%CI: 0.19-0.89, p = 0.025. Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0237831</identifier><identifier>PMID: 32817707</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Bioengineering ; Biology and Life Sciences ; Coronaviruses ; COVID-19 ; Cytokines ; Drug therapy ; Failure ; Health sciences ; Hospitals ; Hydroxychloroquine ; Hygiene ; Immune response ; Immune system ; Immunosuppressive agents ; Infectious diseases ; Inflammation ; Informatics ; Intubation ; Medicine and Health Sciences ; Methylprednisolone ; Monoclonal antibodies ; Mortality ; Neurosciences ; Pandemics ; Patient outcomes ; Patients ; Pharmacy ; Physical Sciences ; Pneumonia ; Regression analysis ; Respiratory failure ; Ritonavir ; Robotics ; Severe acute respiratory syndrome coronavirus 2 ; Steroid hormones ; Steroids ; Supervision ; Survival ; Tocilizumab ; Ventilators ; Viral diseases</subject><ispartof>PloS one, 2020-08, Vol.15 (8), p.e0237831-e0237831</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Mikulska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Mikulska et al 2020 Mikulska et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-ab217348fc3ffe023c1860631fb639e74227379462a8019a247d1607a69747803</citedby><cites>FETCH-LOGICAL-c669t-ab217348fc3ffe023c1860631fb639e74227379462a8019a247d1607a69747803</cites><orcidid>0000-0003-1436-5089 ; 0000-0001-5646-2034 ; 0000-0002-5535-4602 ; 0000-0003-2385-1759 ; 0000-0002-6622-6358</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440633/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440633/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids></links><search><contributor>Adrish, Muhammad</contributor><creatorcontrib>Mikulska, Malgorzata</creatorcontrib><creatorcontrib>Nicolini, Laura Ambra</creatorcontrib><creatorcontrib>Signori, Alessio</creatorcontrib><creatorcontrib>Di Biagio, Antonio</creatorcontrib><creatorcontrib>Sepulcri, Chiara</creatorcontrib><creatorcontrib>Russo, Chiara</creatorcontrib><creatorcontrib>Dettori, Silvia</creatorcontrib><creatorcontrib>Berruti, Marco</creatorcontrib><creatorcontrib>Sormani, Maria Pia</creatorcontrib><creatorcontrib>Giacobbe, Daniele Roberto</creatorcontrib><creatorcontrib>Vena, Antonio</creatorcontrib><creatorcontrib>De Maria, Andrea</creatorcontrib><creatorcontrib>Dentone, Chiara</creatorcontrib><creatorcontrib>Taramasso, Lucia</creatorcontrib><creatorcontrib>Mirabella, Michele</creatorcontrib><creatorcontrib>Magnasco, Laura</creatorcontrib><creatorcontrib>Mora, Sara</creatorcontrib><creatorcontrib>Delfino, Emanuele</creatorcontrib><creatorcontrib>Toscanini, Federica</creatorcontrib><creatorcontrib>Balletto, Elisa</creatorcontrib><creatorcontrib>Alessandrini, Anna Ida</creatorcontrib><creatorcontrib>Baldi, Federico</creatorcontrib><creatorcontrib>Briano, Federica</creatorcontrib><creatorcontrib>Camera, Marco</creatorcontrib><creatorcontrib>Dodi, Ferdinando</creatorcontrib><creatorcontrib>Ferrazin, Antonio</creatorcontrib><creatorcontrib>Labate, Laura</creatorcontrib><creatorcontrib>Mazzarello, Giovanni</creatorcontrib><creatorcontrib>Pincino, Rachele</creatorcontrib><creatorcontrib>Portunato, Federica</creatorcontrib><creatorcontrib>Tutino, Stefania</creatorcontrib><creatorcontrib>Barisione, Emanuela</creatorcontrib><creatorcontrib>Bruzzone, Bianca</creatorcontrib><creatorcontrib>Orsi, Andrea</creatorcontrib><creatorcontrib>Schenone, Eva</creatorcontrib><creatorcontrib>Rosseti, Nirmala</creatorcontrib><creatorcontrib>Sasso, Elisabetta</creatorcontrib><creatorcontrib>Da Rin, Giorgio</creatorcontrib><creatorcontrib>Pelosi, Paolo</creatorcontrib><creatorcontrib>Beltramini, Sabrina</creatorcontrib><creatorcontrib>Giacomini, Mauro</creatorcontrib><creatorcontrib>Icardi, Giancarlo</creatorcontrib><creatorcontrib>Gratarola, Angelo</creatorcontrib><creatorcontrib>Bassetti, Matteo</creatorcontrib><title>Tocilizumab and steroid treatment in patients with COVID-19 pneumonia</title><title>PloS one</title><description>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. 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.sup.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 (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HR.sub.OW). Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO.sub.2 /FiO.sub.2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HR.sub.OW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HR.sub.OW 0.41, 95%CI: 0.19-0.89, p = 0.025. Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.</description><subject>Bioengineering</subject><subject>Biology and Life Sciences</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Cytokines</subject><subject>Drug therapy</subject><subject>Failure</subject><subject>Health sciences</subject><subject>Hospitals</subject><subject>Hydroxychloroquine</subject><subject>Hygiene</subject><subject>Immune response</subject><subject>Immune system</subject><subject>Immunosuppressive agents</subject><subject>Infectious diseases</subject><subject>Inflammation</subject><subject>Informatics</subject><subject>Intubation</subject><subject>Medicine and Health Sciences</subject><subject>Methylprednisolone</subject><subject>Monoclonal antibodies</subject><subject>Mortality</subject><subject>Neurosciences</subject><subject>Pandemics</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Physical Sciences</subject><subject>Pneumonia</subject><subject>Regression analysis</subject><subject>Respiratory failure</subject><subject>Ritonavir</subject><subject>Robotics</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Steroid hormones</subject><subject>Steroids</subject><subject>Supervision</subject><subject>Survival</subject><subject>Tocilizumab</subject><subject>Ventilators</subject><subject>Viral 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and steroid treatment in patients with COVID-19 pneumonia</title><author>Mikulska, Malgorzata ; Nicolini, Laura Ambra ; Signori, Alessio ; Di Biagio, Antonio ; Sepulcri, Chiara ; Russo, Chiara ; Dettori, Silvia ; Berruti, Marco ; Sormani, Maria Pia ; Giacobbe, Daniele Roberto ; Vena, Antonio ; De Maria, Andrea ; Dentone, Chiara ; Taramasso, Lucia ; Mirabella, Michele ; Magnasco, Laura ; Mora, Sara ; Delfino, Emanuele ; Toscanini, Federica ; Balletto, Elisa ; Alessandrini, Anna Ida ; Baldi, Federico ; Briano, Federica ; Camera, Marco ; Dodi, Ferdinando ; Ferrazin, Antonio ; Labate, Laura ; Mazzarello, Giovanni ; Pincino, Rachele ; Portunato, Federica ; Tutino, Stefania ; Barisione, Emanuela ; Bruzzone, Bianca ; Orsi, Andrea ; Schenone, Eva ; Rosseti, Nirmala ; Sasso, Elisabetta ; Da Rin, Giorgio ; Pelosi, Paolo ; Beltramini, Sabrina ; Giacomini, Mauro ; Icardi, Giancarlo ; Gratarola, Angelo ; Bassetti, Matteo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-ab217348fc3ffe023c1860631fb639e74227379462a8019a247d1607a69747803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bioengineering</topic><topic>Biology and Life Sciences</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Cytokines</topic><topic>Drug therapy</topic><topic>Failure</topic><topic>Health sciences</topic><topic>Hospitals</topic><topic>Hydroxychloroquine</topic><topic>Hygiene</topic><topic>Immune response</topic><topic>Immune system</topic><topic>Immunosuppressive agents</topic><topic>Infectious diseases</topic><topic>Inflammation</topic><topic>Informatics</topic><topic>Intubation</topic><topic>Medicine and Health Sciences</topic><topic>Methylprednisolone</topic><topic>Monoclonal antibodies</topic><topic>Mortality</topic><topic>Neurosciences</topic><topic>Pandemics</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Physical Sciences</topic><topic>Pneumonia</topic><topic>Regression analysis</topic><topic>Respiratory failure</topic><topic>Ritonavir</topic><topic>Robotics</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Steroid hormones</topic><topic>Steroids</topic><topic>Supervision</topic><topic>Survival</topic><topic>Tocilizumab</topic><topic>Ventilators</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mikulska, Malgorzata</creatorcontrib><creatorcontrib>Nicolini, Laura Ambra</creatorcontrib><creatorcontrib>Signori, Alessio</creatorcontrib><creatorcontrib>Di Biagio, Antonio</creatorcontrib><creatorcontrib>Sepulcri, Chiara</creatorcontrib><creatorcontrib>Russo, Chiara</creatorcontrib><creatorcontrib>Dettori, Silvia</creatorcontrib><creatorcontrib>Berruti, Marco</creatorcontrib><creatorcontrib>Sormani, Maria Pia</creatorcontrib><creatorcontrib>Giacobbe, Daniele Roberto</creatorcontrib><creatorcontrib>Vena, Antonio</creatorcontrib><creatorcontrib>De Maria, Andrea</creatorcontrib><creatorcontrib>Dentone, Chiara</creatorcontrib><creatorcontrib>Taramasso, Lucia</creatorcontrib><creatorcontrib>Mirabella, Michele</creatorcontrib><creatorcontrib>Magnasco, Laura</creatorcontrib><creatorcontrib>Mora, Sara</creatorcontrib><creatorcontrib>Delfino, Emanuele</creatorcontrib><creatorcontrib>Toscanini, Federica</creatorcontrib><creatorcontrib>Balletto, Elisa</creatorcontrib><creatorcontrib>Alessandrini, Anna Ida</creatorcontrib><creatorcontrib>Baldi, Federico</creatorcontrib><creatorcontrib>Briano, Federica</creatorcontrib><creatorcontrib>Camera, Marco</creatorcontrib><creatorcontrib>Dodi, Ferdinando</creatorcontrib><creatorcontrib>Ferrazin, Antonio</creatorcontrib><creatorcontrib>Labate, Laura</creatorcontrib><creatorcontrib>Mazzarello, Giovanni</creatorcontrib><creatorcontrib>Pincino, Rachele</creatorcontrib><creatorcontrib>Portunato, Federica</creatorcontrib><creatorcontrib>Tutino, Stefania</creatorcontrib><creatorcontrib>Barisione, Emanuela</creatorcontrib><creatorcontrib>Bruzzone, Bianca</creatorcontrib><creatorcontrib>Orsi, Andrea</creatorcontrib><creatorcontrib>Schenone, Eva</creatorcontrib><creatorcontrib>Rosseti, Nirmala</creatorcontrib><creatorcontrib>Sasso, Elisabetta</creatorcontrib><creatorcontrib>Da Rin, Giorgio</creatorcontrib><creatorcontrib>Pelosi, Paolo</creatorcontrib><creatorcontrib>Beltramini, Sabrina</creatorcontrib><creatorcontrib>Giacomini, Mauro</creatorcontrib><creatorcontrib>Icardi, Giancarlo</creatorcontrib><creatorcontrib>Gratarola, Angelo</creatorcontrib><creatorcontrib>Bassetti, Matteo</creatorcontrib><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior 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Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mikulska, Malgorzata</au><au>Nicolini, Laura Ambra</au><au>Signori, Alessio</au><au>Di Biagio, Antonio</au><au>Sepulcri, Chiara</au><au>Russo, Chiara</au><au>Dettori, Silvia</au><au>Berruti, Marco</au><au>Sormani, Maria Pia</au><au>Giacobbe, Daniele Roberto</au><au>Vena, Antonio</au><au>De Maria, Andrea</au><au>Dentone, Chiara</au><au>Taramasso, Lucia</au><au>Mirabella, Michele</au><au>Magnasco, Laura</au><au>Mora, Sara</au><au>Delfino, Emanuele</au><au>Toscanini, Federica</au><au>Balletto, Elisa</au><au>Alessandrini, Anna Ida</au><au>Baldi, Federico</au><au>Briano, Federica</au><au>Camera, Marco</au><au>Dodi, Ferdinando</au><au>Ferrazin, Antonio</au><au>Labate, Laura</au><au>Mazzarello, Giovanni</au><au>Pincino, Rachele</au><au>Portunato, Federica</au><au>Tutino, Stefania</au><au>Barisione, Emanuela</au><au>Bruzzone, Bianca</au><au>Orsi, Andrea</au><au>Schenone, Eva</au><au>Rosseti, Nirmala</au><au>Sasso, Elisabetta</au><au>Da Rin, Giorgio</au><au>Pelosi, Paolo</au><au>Beltramini, Sabrina</au><au>Giacomini, Mauro</au><au>Icardi, Giancarlo</au><au>Gratarola, Angelo</au><au>Bassetti, Matteo</au><au>Adrish, Muhammad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tocilizumab and steroid treatment in patients with COVID-19 pneumonia</atitle><jtitle>PloS one</jtitle><date>2020-08-20</date><risdate>2020</risdate><volume>15</volume><issue>8</issue><spage>e0237831</spage><epage>e0237831</epage><pages>e0237831-e0237831</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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. 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.sup.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 (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HR.sub.OW). Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO.sub.2 /FiO.sub.2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HR.sub.OW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HR.sub.OW 0.41, 95%CI: 0.19-0.89, p = 0.025. Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32817707</pmid><doi>10.1371/journal.pone.0237831</doi><tpages>e0237831</tpages><orcidid>https://orcid.org/0000-0003-1436-5089</orcidid><orcidid>https://orcid.org/0000-0001-5646-2034</orcidid><orcidid>https://orcid.org/0000-0002-5535-4602</orcidid><orcidid>https://orcid.org/0000-0003-2385-1759</orcidid><orcidid>https://orcid.org/0000-0002-6622-6358</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-08, Vol.15 (8), p.e0237831-e0237831 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2435770600 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Bioengineering Biology and Life Sciences Coronaviruses COVID-19 Cytokines Drug therapy Failure Health sciences Hospitals Hydroxychloroquine Hygiene Immune response Immune system Immunosuppressive agents Infectious diseases Inflammation Informatics Intubation Medicine and Health Sciences Methylprednisolone Monoclonal antibodies Mortality Neurosciences Pandemics Patient outcomes Patients Pharmacy Physical Sciences Pneumonia Regression analysis Respiratory failure Ritonavir Robotics Severe acute respiratory syndrome coronavirus 2 Steroid hormones Steroids Supervision Survival Tocilizumab Ventilators Viral diseases |
| title | Tocilizumab and steroid treatment in patients with COVID-19 pneumonia |
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