Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19
10.3349/ymj.2022.63.5.430
- Author:
Jin Yeong HONG
1
;
Jae-Hoon KO
;
Jinyoung YANG
;
Soyoung HA
;
Eliel NHAM
;
Kyungmin HUH
;
Sun Young CHO
;
Cheol-In KANG
;
Doo Ryeon CHUNG
;
Jin Yang BAEK
;
You Min SOHN
;
Hyo Jung PARK
;
Beomki LEE
;
Hee Jae HUH
;
Eun-Suk KANG
;
Gee Young SUH
;
Chi Ryang CHUNG
;
Kyong Ran PECK
Author Information
1. Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Yonsei Medical Journal
2022;63(5):430-439
- CountryRepublic of Korea
- Language:English
-
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 dexamethasone in combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was 30-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 the dexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinical recovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decrease in 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 significantly shorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days; p=0.006). Infectious complications and cellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescence stage were not different between the two groups.
Conclusion:A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improved clinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.
