Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection: A Spanish, Multicenter, Cohort Study
Bele ´n Ruiz-Antora, ´n Ara, Sancho-Lo ´pez Ferra, Torres Vı, Moreno-Torres Itziar De, Pablo-Lo ´pez Paulina Garcı ´a-Lo ´pez, Abad-Santos Francisco, M Clara, Rosso-Ferna ´ndez, Aldea-Perona Ana, Montane ´ Eva, M Ruth, Aparicio-Herna ´ndez, Llop-Rius Roser, Pedro Consuelo, ´s, Gijo ´n Paloma, Carolina Herna ´ndez-Carballo, Marı, J Consuelo Pedrosa-Martı ´nez, Guillermo Rodrı ´guez-Jime ´nez, Lourdes Prada-Ramallal, ´a Cabrera-Garcı, Josefa A Aguilar-Garcı, ´a Rocı, ´o Sanjuan-Jimenez, I Evelyn, Enrique Ortiz-Barraza, Ana Sa ´nchez-Chica, Ferna, B Ruiz-Antora, A Sancho, F Torres, V Moreno-Torres, Á E Sa, F Abad-Santos, C M Rosso-Ferna ´ndez, A Aldea-Perona, R M Aparicio-Herna ´ndez, R Llop-Rius, C Herna ´ndez-Carballo, M J Pedrosa, C Rodrı ´guez-Jime ´nez, L Cabrera, R Sanjuan-Jimenez, Salut Mar X De, P Ferna ´ndez Sala, S Dı ´az Pellicer, Cer- Rato Grau, Universitario Hospital, De, Jose, Dodero Anillo, Alberto Romero, Del Roci, ´o Elisa Cubiles, Lobo Acosta, Reyes Fresneda Gutierrez, Alicia Marı, Cando ´n, Salto Sonsoles, Jose Miguel Alejandre, Elisa Cisneros Herreros, Matı Cordero, Carmen Infante ´a, Juan Dominguez, Cre- Spo Carlos, Macarena Rivas, Verdugo Lo ´pez, Universitario Hospital, Canarias Isabel De, Toste Suarez, Paloma Dı ´az Pe ´rez, Uni- Versitari Hospital, Bellvitge De, Mitjavila Francesca, Guillermo Villero, Carlota Sua ´rez Cuartin, Adriana Iriarte Gudiol Gonzalez, Fuster, Gasa Merce, Sandra Galmes, Dolores Pe ´rez, Rodrı, Cumplido Hospital, Universitario Nra, Sra Candelaria, Arı ´stides De Leo, Emilio J Gil, Sanz, Universitario Hospital General, Valencia De, Francesc Francisco Sanz-Herrero, Pilar Puchades, ´a C H Univ Ortega-Garcı, Santiago De, Compostela De, Carlos Jose ´antonio Dı ´az-Peromingo, Cli Rodrı ´guez-Moreno, San ´nico, Daniel Carlos, Ana Lozano, Terleira, Universitario Hospi- Tal, ´rdenas Torreca, Estela Gonza ´lez Castro, Sergio Ferra Murcia, Elena Marı ´a Ga ´zquez, Aguilera Hospital, Uni- Versitario De, La Elena Princesa, Pablo Pintos- Sanchez, Elena Zubiaur, Marcos Santos-Molina, Gina Navares-Go ´mez, Abril Mejia, L A Defensa Go ´mez, Ulla Amelia Garcı ´a-Luque, Miguel Puerro-Vi- Cente, Marı ´a, Jesu ´s Sa ´nchez, Ramo ´n, Y M Cajal, Mo A ´ngeles Ga ´lvez Mu ´gica, Jime ´nica Aguilar, Cris- Tina ´nez, Sa, Dı ´az Hospital Universitario, Puerta De, Hierro Cristina, Avendan ˜o, Patricia Mills-Sa ´nchez, Manuel Valle, Concepcio Gustavo Centeno, ´n Payares, Antonio F Caballero Bermejo, Elena Diago, Rosa Malo De Molina, Juan Antonio Vargas Nun ˜ez, Elena Mun ˜ez, Antonio Ramos, Univ Hospital, I Germans Trias, Ana Pujol, Ana Pilar Marı ´a Barrio- Canal, Melani Pe ´rez-Acevedoc, Nu ´n ˜ez- Montero, Universitario Hospital, ˜on Gre- Gorio Maran, Marı ´a Olmedo, Andrea Aguilar
doi:10.1007/s40121-020
Background: We aimed to determine the impact of tocilizumab use on severe COVID-19 (coronavirus disease 19) pneumonia mortality. Methods: We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by inverse probability of the treatment weights (IPTW). Tocilizumab's effect in patients receiving steroids during the 48 h following inclusion was analysed. Results: During the study period, 506 patients with severe COVID-19 fulfilled the inclusion Bele ´n Ruiz-Antora ´n and Ara ´nzazu Sancho-Lo ´pez contributed equally to this work.
Authorship Contribution. Conceptualization and study design: ASL, BRA, AFC. Methodology: BRA, AFC, ASL, F-T. Data collection: all authors. Data interpretation: ASL, BRA, AFC, FT. Writing first draft: ASL, BRA, AFC. Critical revision for important intellectual content: all authors. Final approval: All authors. All authors agree to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work will be appropriately investigated and resolved. AFC and BRA had full access to all the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. This manuscript is based on work that has been previously presented at medRxiv, posted 10 September 2020 ( https:// www.medrxiv.org/content/10.1101/2020.09 .
07.20189357v2). Disclosures. Bele ´n Ruiz-Antora ´n, Ara ´nzazu Sancho-Lo ´pez, Ferra ´n Torres, Vı ´ctor Moreno-Torres, Itziar de Pablo-Lo ´pez, Paulina Garcı ´a-Lo ´pez, Francisco Abad-Santos, Clara M. Rosso-Ferna ´ndez, Ana Aldea-Perona, Eva Montane ´, Ruth M. Aparicio-Herna ´ndez, Roser Llop-Rius, Consuelo Pedro ´s, Paloma Gijo ´n, Carolina Herna ´ndez-Carballo, Marı ´a J Pedrosa-Martı ´nez, Consuelo Rodrı ´guez-Jime ´nez, Guillermo Prada-Ramallal, Lourdes Cabrera-Garcı ´a, Josefa A. Aguilar-Garcı ´a, Rocı ´o Sanjuan-Jimenez, Evelyn I. Ortiz-Barraza, Enrique Sa ´nchez-Chica and Ana Ferna ´ndez-Cruz declare no conflicts of interest...
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