Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state : a multicentre cohort study (SAM-COVID-19)

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved..

OBJECTIVES: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters.

METHODS: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).

RESULTS: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001).

CONCLUSIONS: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.

Media Type:

Electronic Article
Cover Image
cover

Year of Publication:

2021

Contained In:

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - Vol. 27, No. 2 (2021), p. 244-252

Language:

English

Contributors:

Rodríguez-Baño, Jesús
Pachón, Jerónimo
Carratalà, Jordi
Ryan, Pablo
Jarrín, Inmaculada
Yllescas, María
Arribas, José Ramón
Berenguer, Juan
SAM-COVID Study Group
Fundación SEIMC-GESIDA
Hospital Universitario La Paz
Hospital Universitario Gregorio Marañón
Hospital Infanta Leonor
Complejo Hospitalario Virgen de la Salud
Hospital Universitario Rafael Méndez
Hospital Universitario de Cruces
Hospital de Melilla
Hospital San Eloy de Barakaldo
Hospital Universitario Central de Asturias
Hospital Universitario Puerto Real
Hospital do Salnés
Hospital del Mar
Hospital Virgen de la Arrixaca
Hospital Clínico San Cecilio
Parc Sanitari Sant Joan de Déu
Hospital Josep Trueta
Hospital Dos De Maig - Consorci Sanitari Integral
Hospital Clínico Universitario de Valencia
Complejo Asistencial de Ávila
Hospital Universitario Marqués de Valdecilla
Hospital de Barcelona SCIAS
Hospital Álvaro Cunqueiro
Hospital Universitario Severo Ochoa
Hospital CIMA-Sanitas
Hospital La Inmaculada
Hospital de Guadalajara
Hospital Universitario Infanta Sofia
Hospital Comarcal de Blanes
Hospital Universitario de Gran Canaria Dr Negrín
Hospital Son Espases
Complejo Hospitalario Universitario A Coruña
Hospital Costa del Sol
Hospital Clínico Universitario Lozano Blesa
Hospital Mutua de Terrassa
Hospital Universitario Virgen Macarena
Hospital Universitari de Bellvitge
Hospital Universitario y Politécnico La Fe
Hospital de Sabadell (Parc Tauli)
Hospital Fundación Jiménez Díaz
Hospital Clínico Universitario de Valladolid
Hospital Son Llatzer
Hospital Universitario de Álava
Complejo Hospitalario Universitario Santa Lucía
Hospital General Universitario Reina Sofía
Complejo Hospitalario Universitario de Ferrol
Hospital Universitario los Arcos del Mar Menor
Hospital Universitario de Jerez
Hospital de Donostia
Hospital Juan Ramón Jiménez
Hospital Vega Baja
Hospital Puerta de Hierro
Hospital Universitario de Getafe
Hospital General de la Palma
Fundación Hospital de Calahorra
Hospital Alto Deba
Hospital Universitario de Jaén
Hospital de Palamós
Hospital Universitario de Valme
Hospital Universitario Virgen del Rocío
Hospital Universitario Ramón y Cajal
Hospital Universitario San Pedro
Hospital Regional de Málaga
Aznar Muñoz, Esther
Gil Divasson, Pedro
González Muñiz, Patricia
Muñoz Aguirre, Clara
Díaz Menéndez, Marta
de la Calle Prieto, Fernando
Arsuaga Vicente, Marta
Trigo Esteban, Elena
Pérez Valero, Ignacio
de Miguel Buckley, Rosa
Cadiñaños Loidi, Julen
Diaz Pollan, Beatriz
Martín Carbonero, Luz
Ramos Ramos, Juan Carlos
Loeches Yagüe, Belén
Montejano Sánchez, Rocío
González García, Juan
García Rodríguez, Julio
Berenguer, Juan
Ramírez, Margarita
Gutiérrez, Isabel
Tejerina, Francisco
Aldámiz-Echevarría, Teresa
Díez, Cristina
Fanciulli, Chiara
Pérez-Latorre, Leire
Pinilla, Blanca
López, Juan Carlos
Such Diaz, Ana
Álvaro Alonso, Elena
Torres Macho, Juan
Cuevas Tascon, Guillermo
Jiménez González de Buitrago, Eva
Brañas Baztán, Fátima
Valencia de la Rosa, Jorge
Pérez Butragueño, Mario
Fernández Jiménez, Inés
Muñiz Nicolás, Gemma
Sepúlveda Berrocal, Antonia
Gato Díez, Alberto
Toledano Sierra, María Pilar
García Butenegro, María Paz
Peláez Ballesta, Ana Isabel
Morcillo Rodríguez, Elena
Fernández Romero, Isidoro
Peláez Ballesta, Cristina
Guirado Torrecillas, María Isabel
Goikoetxea Agirre, Josune
Bereciartua Bastarrica, Elena
Guio Carrión, Laura
Rodríguez Álvarez, Regino
Ibarrola Hierro, Marta
Pérez Hernández, Isabel A
Pérez Zapata, Inés
Román Soto, Sergio
Kallouchi, Mohamed
Domínguez Vicent, Juan Ramón
Silvariño Fernández, Rafae
Ugalde Espiñeira, Jon
Sanjuan López, Ainhoa
García Martínez, Silvia
Temprano Gogenola, Mikel
Asensi, Víctor
Suárez, Silvia
Suárez, Lucia
Yllera, Carmen
Rivas-Carmenado, María
Romero-Palacios, Alberto
Ruiz Aragón, Jesús
Jiménez Aguilar, Patricia
Fernández Ávila, Ma Luisa
Castilla Ortiz, Rosario
Alende Castro, Vanesa
Pérez García, Cristina
Fernández Morales, Marta
Valle Feijoo Begoña Rodríguez Ferreira, María Lorena María
Gómez-Junyent, Joan
Villar-García, Judit
López-Montesinos, Inmaculada
Arrieta-Aldea, Itziar
Rial-Villavecchia, Abora
García Vázquez, Elisa
Roura Piloto, Aychel Elena
Moral Escudero, Encarnación
Hernández Torres, Alicia
Albendín Iglesias, Helena
Vinuesa García, David
Martínez Montes, Clara
De la Hera Fernández, Francisco Javier
Anguita Santos, Francisco
Ruiz Sancho, Andrés
Díaz de Brito Fernández, Vicens
Sanmarti Vilamala, Montserrat
España Cueto, Sergio
Molina Morant, Daniel
González-Cuevas, Araceli
Chara Cervantes, Joel Elías
Policarpo Torres, Guillem
Ortega Montoliu, Meritxell
Angerri Nadal, Mònica
De Genover Gil, Ariadna
Patera, Eleni
Godoy Lorenzo, Rita
Zioga, Evangelia Anna María
Isern Fernández, Virginia
Sabbagh Fajardo, Carlos Enrique
Ferrer Ribera, Ana
Bea Serrano, Carlos
Oltra Sempere, Rosa
Vela Bernal, Sara
Albiol Viñals, Paloma
Pedromingo Kus, Miguel
Garcinuño, María Ángeles
Fiorante, Silvana
Pérez Pinto, Sergio
de la Vega, Alexandra
Fariñas Álvarez, María Carmen
González Rico, Claudia
Arnaiz de Las Revillas, Francisco
Giménez, Teresa
Calvo, Jorge
Meije Castillo, Yolanda
Duarte Borges, Alejandra
Pareja Coca, Júlia
Clemente Presas, Mercedes
Sanz Salvador, Xavier
Pérez Rodríguez, Ma Teresa
Sousa, Adrián
Pérez González, Alexandre
Longueira, Rebeca
Araujo, Alejandro
Alonso Martínez, Blanca
García Escudero, Laura
Lidia Kamel Rey, Sara
Roa Alonso, David
Avilés Parra, Juan Pablo
Pelegrín Senent, Iván
Rouco Esteves Marques, Rosana
Raich Montiu, Laia
Souto Higueras, Jessica
Gálvez Bobadilla, Manuel Alejandro
Parra Ruiz, Jorge
Ramos Sesma, Violeta
Velasco Fuentes, Sara
García Pereña, Laura
Lluna Carrascosa, Alfonso
Gilaberte Reyzábal, Sergio
Liébana Gómez, Mónica
Salillas Hernando, Juan
Serrano Martínez, Alberto
Torralba González de Suso, Miguel
Martínez Martín, Patricia
Rábago Lorite, Isabel
González-Ruano Pérez, Patricia
Pérez-Monte Mínguez, Beatriz
García Flores, Ángeles
Comas Casanova, Pere
Martín Plata, Andrea
Santana Báez, Sergio Manuel
Sanz Peláez, Oscar
Mohamed Ramírez, Karim
Robaina Bordón, José María
Vílchez Rueda, Helem Haydeé
Riera Jaume, Melchor
Mut Ramon, Gemma
Gavalda Manso, Meritxell
Planas Bibiloni, Lluis
Castelo Corral, Laura
Ramos Merino, Lucía
Sánchez Vidal, Efrén
Rodríguez Mayo, María
Míguez Rey, Enrique
García de Lomas Guerrero, José M
De la Torre Lima, Javier
Correa Ruiz, Ana
Fernández Sánchez, Fernando
Jiménez-García, Nicolás
Sierra-Monzón, José Luis
Gracia-Tello, Borja
Hernández-Bonaga, María
Pellejero, Galadriel
Asín-Corrochano, Marta
Boix Palop, Lucia
Calbo, Esther
Badía, Cristina
Dietl, Beatriz
Lucía, Gómez
Domínguez-Castellano, Ángel
Ríos-Villegas, María José
Del Toro, María D
Palacios Baena, Zaira R
Salamanca-Rivera, Elena
Marín, Elena
Almadana, Virginia
Pérez-Galera, Salvador
González-Iglesias, Luisa
Abelenda-Alonso, Gabriela
Álvarez-Pouso, Claudia
Escrihuela, Francesc
Gudiol, Carlota
Lorenzo-Esteller, Laia
Niubó, Jordi
Podzamczer, Daniel
Pujol, Miquel
Rombauts, Alexander
Salvert Lletí, Miguel
Gil Sánchez, Ricardo
Jiménez Escrig, Marta
Parra Gómez, Laura
Tasias Pitarch, Mariona
Navarro Vilasaró, Marta
Machado Sicilia, María Luisa
Gomila Grange, Aina
Calzado Isbert, Sonia
Carrasco Antón, Nerea
Petkova-Saiz, Elizabet
Cabello Úbeda, Alfonso
Górgolas Hernández-Mora, Miguel
Sánchez-Pernaute, Olga
Dueñas Gutiérrez, Carlos
Martin Guerra, Javier
Castrodeza Sanz, José Javier
Fernández Espinilla, Virginia
Rodríguez Fernández, Laura
González-Moreno, Juan
Villoslada Gelabert, Aroa
Ribot Sanso, María Antonia
Fernández-Baca, María Victoria
Hernández Milian, Almudena
Morán Rodríguez, Miguel Ángel
Ortiz de Zárate Ibarra, Zuriñe
Portu Zapirain, José Joaquin
Saez de Adana Arroniz, Ester
Gainzarain Arana, Juan Carlos
Meca Birlanga, Olga
Del Amor Espín, Ma Jesús
Viqueira González, Montserrat
García García, Josefina
Martínez Madrid, Onofre
Bernal Morell, Enrique
Alcaraz, Antonia
Muñoz, Ángeles
Pina, Ignacio
de la Rosa, Vicente
Caínzos Romero, Tamara
Sánchez Trigo, Sabela
Mariño Callejo, Ana Isabel
Álvarez Díaz, Hortensia
Valcarce Pardeiro, Nieves
Sánchez Serrano, Adriana
Piñar Cabezos, Diana
García Villalba, Eva Pilar
Aguayo Jiménez, Carmen
Ruíz Campuzano, María
Naranjo Velasco, Virginia
Santos Peña, Marta
Mora Delgado, Juan
Sevilla Moreno, Israel
Lojo Cruz, Cristina
Kortajarena Urkola, Xabier
Iribarren Loyarte, José Antonio
Bustinduy Odriozola, María Jesús
Ibarguren Pinilla, Maialen
Álvarez Rodríguez, Ignacio
Martínez Marcos, Francisco Javier
Rodríguez Gómez, Francisco Javier
Asschert Agüero, Isabel
Muñoz Beamud, Francisco
Ruiz Reina, Antonio José
Llenas-García, Jara
González-Cuello, Inmaculada
Hellín-Valiente, Elena
Martínez Birlanga, Esther
Tafalla Torres, José Manuel
Calderón Parra, Jorge
Escudero López, Gabriela
Gutiérrez Martín, Isabel
Andrés Eisenhofer, Ane
García Prieto, Sonia
Álvarez Franco, Raquel
Roger Zapata, Daniel
Martínez Cifre, Blanca
Aranda Rife, Elena
Martín Rubio, Irene
Barbosa Ventura, André
Garrido, Javier
Gonzalo, Concepción
Piñero, Iván
de la Cruz Felipe, Nieves
Talavera García, Eva
Lamata Subero, Marta
Mendoza Roy, Paula
García de Carlos, María Soledad
Lajusticia Aisa, Justo
Arteche Eguizabal, Lorea
Urrutia Losada, Ainhoa
Domingo Echaburu, Saioa
Cuadros Tito, Pedro Ángel
Orbe Narváez, Gurutz
Liébana Martos, Ma Del Carmen
Roldán Fontana, Carolina
Herrero Rodríguez, Carmen
Duro Ruiz, Gaspar
Pérez Parra, Santiago
Mera Fidalgo, Arantzazu
Hortos Alsina, Miquel
Alberich Conesa, Ana
Bladé Vidal, Lourdes
Merchante Gutiérrez, Nicolás
León Jiménez, Eva
Espíndola Gómez, Reinaldo
Erostarbe Gallardo, María
Martínez Pérez-Crespo, Pedro
Cisneros, José Miguel
Aguilar-Guisado, Manuela
Aldabó, Teresa
Bueno, Claudio
Cordero-Matía, Elisa
Escoresca, Ana
Infante, Carmen
Guillermo, Martín
Salto, Sonsoles
Gioia, Francesca
Vizcarra, Pilar
Fortún Abete, Jesús
Martín Dávila, Pilar
Moreno Guillén, Santiago
Oteo Revuelta, José A
García-García, Concepción
Santibañez Sáenz, Paula
Cervera Acedo, Cristina
Azcona Gutiérrez, José M
Reguera Iglesias, José María
Plata Ciezar, Antonio
Valiente de Santis, Lucia
Sobrino Diaz, Beatriz
Ruiz Mesa, Juan Diego

Urls:

Volltext

Keywords:

COVID-19
Cohort study
Corticosteroids
Hyperinflammatory state
Journal Article
Mortality
Tocilizumab

Notes:

Date Revised 19.02.2021

published: Print-Electronic

Citation Status In-Process

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1016/j.cmi.2020.08.010

PMID:

32860964

PPN (Catalogue-ID):

NLM315284951