Corticosteroids plus tocilizumab superior to standard of car
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Corticosteroids plus tocilizumab demonstrated superior survival outcomes compared with standard or care and corticosteroids alone, or alongside anakinra, in patients with COVID-19 cytokine storm, according to data published in Chest.

This study aimed to find if immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm (CCS).

Researchers conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020, and April 24, 2020, were included. CCS was defined by inflammatory markers: ferritin greater than 700 ng/mL; C-reactive protein (CRP), greater than 30 mg/dL; or lactate dehydrogenase (LDH), greater than 300 U/L.

Patients were subdivided into six groups: no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-IL-6 antibody (tocilizumab), or anti-IL-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality.

Results:
-- Five thousand seven hundred seventy-six patients met the inclusion criteria. The most common comorbidities were hypertension (44%-59%), diabetes (32%-46%), and cardiovascular disease (5%-14%).

-- Patients most frequently met criteria with high LDH (76.2%) alone or in combination, followed by ferritin (63.2%) and CRP (8.4%).

-- More than 80% of patients showed an elevated D-dimer. Patients treated with corticosteroids and tocilizumab combination showed lower mortality compared with patients receiving standard-of-care (SoC) treatment and with patients treated with corticosteroids alone or in combination with anakinra.

-- Corticosteroids when administered alone or in combination with tocilizumab or anakinra improved hospital survival compared with SoC treatment.

Conclusively, the combination of corticosteroids with tocilizumab showed superior survival outcome when compared with SoC treatment and treatment with corticosteroids alone or in combination with anakinra. Furthermore, corticosteroid use either alone or in combination with tocilizumab or anakinra was associated with reduced hospital mortality for patients with CCS compared with patients receiving SoC treatment.

Source: https://journal.chestnet.org/article/S0012-3692(20)34901-1/fulltext
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