Adding corticosteroid to tocilizumab equates to better survival in severe COVID-19

Severe COVID-19 patients receiving tocilizumab (TCZ) for systemic host-immune inflammatory response syndrome see survival benefits with add-on corticosteroid therapy, as shown in a study.

The real-world retrospective analysis included 186 consecutive adult patients (mean age, 64.3 years; 69.4 percent male) with severe COVID-19 being treated with tocilizumab. Of these, 129 (87.8 percent) received corticosteroid as an add-on therapy.

When TCZ was initiated, 155 patients (83.3 percent) were on noninvasive ventilation and 63 (33.9 percent) were admitted into semi-critical/critical care units. TCZ was administered within a mean of 12 days from symptoms onset and 4.3 days from hospital admission. Overall, 147 patients (79 percent) survived and 39 (21 percent) died.

Compared with survivors, those who died were older (62.1 years vs 72.4 years; p<0.001) and more frequently had a previous diagnosis of chronic heart failure (1.4 percent vs 12.8 percent; p=0.005) and/or chronic liver disease (2 percent vs 10.3 percent; p=0.036). Significantly more survivors received corticosteroid in combination with TCZ (87.8 percent vs 69.2 percent; p=0.021).

On multivariate Cox analysis, risk factors for mortality were older age (hazard ratio [HR], 1.09; p<0.001), chronic heart failure (HR, 4.4; p=0.003), and chronic liver disease (HR, 4.69; p=0.004).

On the other hand, the use of corticosteroid in combination with TCZ was associated with lower mortality (HR, 0.26; p<0.001).

There were no serious superinfections recorded after a 30-day follow-up.

Despite the encouraging findings, questions remain regarding the best time to administer TCZ and corticosteroid in severe COVID-19, as well as the best regimen and most appropriate doses.