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. To examine whether immunomodulatory therapies improve survival among patients with COVID-19 cytokine storm, Narain and colleagues conducted a retrospective analysis of electronic health records across the Northwell Health system, based in Great Neck, New York. In all, the researchers included 5,776 patients with COVID-19 hospitalized between March 1 and April 24. Cytokine storm was defined through inflammatory markers — ferritin levels greater than 700 ng/mL, C-reactive protein of more than 30 mg/dL or lactate dehydrogenase levels of more than 300 U/L.

All included patients were categorized into one of six groups. These included one standard of care group, defined as those who received no immunomodulatory treatment, and five groups in which participants received either corticosteroids, tocilizumab (Actemra, Genentech) or anakinra (Kineret, SOBI) alone or in combination with corticosteroids. The primary outcome was hospital mortality.

According to the researchers, patients treated with corticosteroids plus tocilizumab demonstrated lower mortality compared to those who received standard of care. The tocilizumab-corticosteroids combination also resulted in survival outcomes that were superior to corticosteroids alone, as well as corticosteroids plus anakinra. Meanwhile, corticosteroids, either alone or in combination with tocilizumab or anakinra improved hospital survival compared with standard of care.

“Our study is the largest retrospective analysis to date reporting on outcomes comparing the use of immunomodulatory therapies such as corticosteroids, tocilizumab and anakinra in the treatment of COVID-19 CCS,” Narain and colleagues wrote. “Our findings suggest that patients receiving steroids and tocilizumab had the lowest mortality of all treatment groups. Corticosteroid use, either alone or in combination with tocilizumab or anakinra, was associated with lower hospital mortality compared to standard of care.”

“A randomized clinical trial with head-to-head comparison of tocilizumab plus corticosteroids versus corticosteroids alone is warranted,” they added. “Further investigation into the effect of dosing and timing of these drugs also needs to be elucidated.”

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