Tocilizumab and steroid treatment in patients with COVID-19 pneumonia

  1. MIKULSKA, MALGORZATA ORCID logo
  2. Nicolini, Laura Ambra
  3. Signori, Alessio
  4. Di Biagio, Antonio ORCID logo
  5. Sepulcri, Chiara
  6. Russo, Chiara
  7. Dettori, Silvia
  8. Berutti, Marco
  9. Sormani, Maria Pia
  10. Giacobbe, Daniele Roberto ORCID logo
  11. Vena, Antonio
  12. De Maria, Andrea
  13. Dentone, Chiara
  14. Taramasso, Lucia ORCID logo
  15. Mirabella, Michele
  16. Magnasco, Laura
  17. Mora, Sara
  18. Delfino, Emanuele
  19. Toscanini, Federica
  20. Balletto, Elisa
  21. Alessandrini, Anna Ida
  22. Baldi, Federico
  23. Briano, Federica
  24. Camera, Marco
  25. Dodi, Ferdinando
  26. Ferrazin, Antonio
  27. Labate, Laura
  28. Mazzarello, Giovanni
  29. Pincino, Rachele
  30. Portunato, Federica
  31. Tutino, Stefania
  32. Barisione, Emanuela
  33. Bruzzone, Bianca
  34. Orsi, Andrea
  35. Schenone, Eva
  36. Rosseti, Nirmala
  37. Sasso, Elisabetta
  38. Da Rin, Giorgio
  39. Pelosii, Paolo
  40. Beltramini, Sabrina
  41. Giacomini, Mauro ORCID logo
  42. Icardi, Giancarlo
  43. Gratarola, Angelo
  44. Bassetti, Matteo

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WeightNameValue
1000 Titel
  • Tocilizumab and steroid treatment in patients with COVID-19 pneumonia
1000 Autor/in
  1. MIKULSKA, MALGORZATA |
  2. Nicolini, Laura Ambra |
  3. Signori, Alessio |
  4. Di Biagio, Antonio |
  5. Sepulcri, Chiara |
  6. Russo, Chiara |
  7. Dettori, Silvia |
  8. Berutti, Marco |
  9. Sormani, Maria Pia |
  10. Giacobbe, Daniele Roberto |
  11. Vena, Antonio |
  12. De Maria, Andrea |
  13. Dentone, Chiara |
  14. Taramasso, Lucia |
  15. Mirabella, Michele |
  16. Magnasco, Laura |
  17. Mora, Sara |
  18. Delfino, Emanuele |
  19. Toscanini, Federica |
  20. Balletto, Elisa |
  21. Alessandrini, Anna Ida |
  22. Baldi, Federico |
  23. Briano, Federica |
  24. Camera, Marco |
  25. Dodi, Ferdinando |
  26. Ferrazin, Antonio |
  27. Labate, Laura |
  28. Mazzarello, Giovanni |
  29. Pincino, Rachele |
  30. Portunato, Federica |
  31. Tutino, Stefania |
  32. Barisione, Emanuela |
  33. Bruzzone, Bianca |
  34. Orsi, Andrea |
  35. Schenone, Eva |
  36. Rosseti, Nirmala |
  37. Sasso, Elisabetta |
  38. Da Rin, Giorgio |
  39. Pelosii, Paolo |
  40. Beltramini, Sabrina |
  41. Giacomini, Mauro |
  42. Icardi, Giancarlo |
  43. Gratarola, Angelo |
  44. Bassetti, Matteo |
1000 Erscheinungsjahr 2020
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2020-08-20
1000 Erschienen in
1000 Quellenangabe
  • 15(8):e0237831
1000 Copyrightjahr
  • 2020
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1371/journal.pone.0237831 |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440633/ |
1000 Ergänzendes Material
  • https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237831#sec021 |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • INTRODUCTION: 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. METHODS: 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 24th, 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 (HROW). RESULTS: 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 PaO2/FiO2 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), HROW 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), HROW 0.41, 95%CI: 0.19–0.89, p = 0.025. CONCLUSION: Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.
1000 Sacherschließung
gnd 1206347392 COVID-19
lokal C-reactive proteins
lokal Ferritin
lokal Hospitals
lokal Steroids
lokal Cytokine therapy
lokal Pneumonia
lokal Oxygen
1000 Fächerklassifikation (DDC)
1000 Liste der Beteiligten
  1. https://orcid.org/0000-0002-5535-4602|https://frl.publisso.de/adhoc/uri/Tmljb2xpbmksIExhdXJhIEFtYnJh|https://frl.publisso.de/adhoc/uri/U2lnbm9yaSwgQWxlc3Npbw==|https://orcid.org/0000-0003-1436-5089|https://frl.publisso.de/adhoc/uri/U2VwdWxjcmksIENoaWFyYQ==|https://frl.publisso.de/adhoc/uri/UnVzc28sIENoaWFyYQ==|https://frl.publisso.de/adhoc/uri/RGV0dG9yaSwgU2lsdmlh|https://frl.publisso.de/adhoc/uri/QmVydXR0aSwgTWFyY28=|https://frl.publisso.de/adhoc/uri/U29ybWFuaSwgTWFyaWEgUGlh|https://orcid.org/0000-0003-2385-1759|https://frl.publisso.de/adhoc/uri/VmVuYSwgQW50b25pbw==|https://frl.publisso.de/adhoc/uri/RGUgTWFyaWEsIEFuZHJlYQ==|https://frl.publisso.de/adhoc/uri/RGVudG9uZSwgQ2hpYXJh|https://orcid.org/0000-0002-6622-6358|https://frl.publisso.de/adhoc/uri/TWlyYWJlbGxhLCBNaWNoZWxl|https://frl.publisso.de/adhoc/uri/TWFnbmFzY28sIExhdXJh|https://frl.publisso.de/adhoc/uri/TW9yYSwgU2FyYQ==|https://frl.publisso.de/adhoc/uri/RGVsZmlubywgRW1hbnVlbGU=|https://frl.publisso.de/adhoc/uri/VG9zY2FuaW5pLCBGZWRlcmljYQ==|https://frl.publisso.de/adhoc/uri/QmFsbGV0dG8sIEVsaXNh|https://frl.publisso.de/adhoc/uri/QWxlc3NhbmRyaW5pLCBBbm5hIElkYQ==|https://frl.publisso.de/adhoc/uri/QmFsZGksIEZlZGVyaWNv|https://frl.publisso.de/adhoc/uri/QnJpYW5vLCBGZWRlcmljYQ==|https://frl.publisso.de/adhoc/uri/Q2FtZXJhLCBNYXJjbw==|https://frl.publisso.de/adhoc/uri/RG9kaSwgRmVyZGluYW5kbw==|https://frl.publisso.de/adhoc/uri/RmVycmF6aW4sIEFudG9uaW8=|https://frl.publisso.de/adhoc/uri/TGFiYXRlLCBMYXVyYQ==|https://frl.publisso.de/adhoc/uri/TWF6emFyZWxsbywgR2lvdmFubmk=|https://frl.publisso.de/adhoc/uri/UGluY2lubywgUmFjaGVsZQ==|https://frl.publisso.de/adhoc/uri/UG9ydHVuYXRvLCBGZWRlcmljYQ==|https://frl.publisso.de/adhoc/uri/VHV0aW5vLCBTdGVmYW5pYQ==|https://frl.publisso.de/adhoc/uri/QmFyaXNpb25lLCBFbWFudWVsYQ==|https://frl.publisso.de/adhoc/uri/QnJ1enpvbmUsIEJpYW5jYQ==|https://frl.publisso.de/adhoc/uri/T3JzaSwgQW5kcmVh|https://frl.publisso.de/adhoc/uri/U2NoZW5vbmUsIEV2YQ==|https://frl.publisso.de/adhoc/uri/Um9zc2V0aSwgTmlybWFsYQ==|https://frl.publisso.de/adhoc/uri/U2Fzc28sIEVsaXNhYmV0dGE=|https://frl.publisso.de/adhoc/uri/RGEgUmluLCBHaW9yZ2lv|https://frl.publisso.de/adhoc/uri/UGVsb3NpaSwgUGFvbG8=|https://frl.publisso.de/adhoc/uri/QmVsdHJhbWluaSwgU2FicmluYQ==|https://orcid.org/0000-0001-5646-2034|https://frl.publisso.de/adhoc/uri/SWNhcmRpLCBHaWFuY2FybG8=|https://frl.publisso.de/adhoc/uri/R3JhdGFyb2xhLCBBbmdlbG8=|https://frl.publisso.de/adhoc/uri/QmFzc2V0dGksIE1hdHRlbw==
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