Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19

• Published in: Yonsei medical journal Vol. 63; no. 5; pp. 430 - 439
• Main Authors: Hong, Jin Yeong, Ko, Jae-Hoon, Yang, Jinyoung, Ha, Soyoung, Nham, Eliel, Huh, Kyungmin, Cho, Sun Young, Kang, Cheol-In, Chung, Doo Ryeon, Baek, Jin Yang, Sohn, You Min, Park, Hyo Jung, Lee, Beomki, Huh, Hee Jae, Kang, Eun-Suk, Suh, Gee Young, Chung, Chi Ryang, Peck, Kyong Ran
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.05.2022; 연세대학교의과대학
• Subjects: Antibodies, Monoclonal, Humanized; COVID-19 - drug therapy; Dexamethasone - therapeutic use; Humans; Original; Retrospective Studies; SARS-CoV-2; Treatment Outcome; 의학일반; COVID-19; tocilizumab; Dexamethasone; immune response
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2022.63.5.430

Real-world experience with tocilizumab in combination with dexamethasone in patients with severe coronavirus disease (COVID-19) needs to be investigated. 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. 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 ( =0.024). In multivariable analyses, peak FiO within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all <0.05). The DexaToci group showed a significantly steeper decrease in FiO (-4.2±2.6) than the Dexa group (-2.7±2.6; =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; =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. 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.