Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19
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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 dexamethasonein combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was30-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 thedexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinicalrecovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combinationwere consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decreasein 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 significantlyshorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days; p=0.006). Infectious complications andcellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescencestage were not different between the two groups. Conclusion: A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improvedclinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.
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 dexamethasonein combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was30-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 thedexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinicalrecovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combinationwere consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decreasein 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 significantlyshorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days; p=0.006). Infectious complications andcellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescencestage were not different between the two groups. Conclusion: A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improvedclinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.
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