Downloads provided by UsageCountsTreatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
Copyright policy ) Rodríguez-Baño, Jesús; Pachón, Jerónimo; Carratalà, Jordi; Ryan, Pablo; Jarrín, Inmaculada; Yllescas, María; Arribas, José Ramón; +193 Authors
Rodríguez-Baño, Jesús; Pachón, Jerónimo; Carratalà, Jordi; Ryan, Pablo; Jarrín, Inmaculada; Yllescas, María; Arribas, José Ramón; Berenguer, Juan; Aznar Muñoz, Esther; Gil Divasson, Pedro; González Muñiz, Patricia; Muñoz Aguirre, Clara; Díaz Menéndez, Marta; de la Calle Prieto, Fernando; Arsuaga Vicente, Marta; Trigo Esteban, Elena; Pérez Valero, Ignacio; de Miguel Buckley, Rosa; Cadiñaños Loidi, Julen; Diaz Pollan, Beatriz; Martín Carbonero, Luz; Ramos Ramos, Juan Carlos; Loeches Yagüe, Belén; Montejano Sánchez, Rocío; González García, Juan; García Rodríguez, Julio; Berenguer, Juan; Ramírez, Margarita; Gutiérrez, Isabel; Tejerina, Francisco; Aldámiz-Echevarría, Teresa; Díez, Cristina; Fanciulli, Chiara; Pérez-Latorre, Leire; Pinilla, Blanca; López, Juan Carlos; Such Diaz, Ana; Álvaro Alonso, Elena; Torres Macho, Juan; Cuevas Tascon, Guillermo; Jiménez González de Buitrago, Eva; Brañas Baztán, Fátima; Valencia de la Rosa, Jorge; Pérez Butragueño, Mario; Fernández Jiménez, Inés; Muñiz Nicolás, Gemma; Sepúlveda Berrocal, Antonia; Gato Díez, Alberto; Toledano Sierra, María Pilar; García Butenegro, María Paz; Peláez Ballesta, Ana Isabel; Morcillo Rodríguez, Elena; Fernández Romero, Isidoro; Peláez Ballesta, Cristina; Guirado Torrecillas, María Isabel; Goikoetxea Agirre, Josune; Bereciartua Bastarrica, Elena; Guio Carrión, Laura; Rodríguez Álvarez, Regino; Ibarrola Hierro, Marta; Pérez Hernández, Isabel A.; Pérez Zapata, Inés; Román Soto, Sergio; Kallouchi, Mohamed; Domínguez Vicent, Juan Ramón; Silvariño Fernández, Rafae; Ugalde Espiñeira, Jon; Sanjuan López, Ainhoa; García Martínez, Silvia; Temprano Gogenola, Mikel; Asensi, Víctor; Suárez, Silvia; Suárez, Lucia; Yllera, Carmen; Rivas-Carmenado, María; Romero-Palacios, Alberto; Ruiz Aragón, Jesús; Jiménez Aguilar, Patricia; Fernández Ávila, Ma Luisa; Castilla Ortiz, Rosario; Alende Castro, Vanesa; Pérez García, Cristina; Fernández Morales, Marta; Valle Feijoo Begoña Rodríguez Ferreira, María Lorena María; Gómez-Junyent, Joan; Villar-García, Judit; López-Montesinos, Inmaculada; Arrieta-Aldea, Itziar; Rial-Villavecchia, Abora; García Vázquez, Elisa; Roura Piloto, Aychel Elena; Moral Escudero, Encarnación; Hernández Torres, Alicia; Albendín Iglesias, Helena; Vinuesa García, David; Martínez Montes, Clara; De la Hera Fernández, Francisco Javier; Anguita Santos, Francisco; Ruiz Sancho, Andrés; Díaz de Brito Fernández, Vicens; Sanmarti Vilamala, Montserrat; España Cueto, Sergio; Molina Morant, Daniel; González-Cuevas, Araceli; Chara Cervantes, Joel Elías; Policarpo Torres, Guillem; Ortega Montoliu, Meritxell; Angerri Nadal, Mònica; De Genover Gil, Ariadna; Patera, Eleni; Godoy Lorenzo, Rita; Zioga, Evangelia Anna María; Isern Fernández, Virginia; Sabbagh Fajardo, Carlos Enrique; Ferrer Ribera, Ana; Bea Serrano, Carlos; Oltra Sempere, Rosa; Vela Bernal, Sara; Albiol Viñals, Paloma; Pedromingo Kus, Miguel; Garcinuño, María Ángeles; Fiorante, Silvana; Pérez Pinto, Sergio; de la Vega, Alexandra; Fariñas Álvarez, María Carmen; González Rico, Claudia; Arnaiz de las Revillas, Francisco; Giménez, Teresa; Calvo, Jorge; Meije Castillo, Yolanda; Duarte Borges, Alejandra; Pareja Coca, Júlia; Clemente Presas, Mercedes; Sanz Salvador, Xavier; Pérez Rodríguez, Ma Teresa; Sousa, Adrián; Pérez González, Alexandre; Longueira, Rebeca; Araujo, Alejandro; Alonso Martínez, Blanca; García Escudero, Laura; Lidia Kamel Rey, Sara; Roa Alonso, David; Avilés Parra, Juan Pablo; Pelegrín Senent, Iván; Rouco Esteves Marques, Rosana; Raich Montiu, Laia; Souto Higueras, Jessica; Gálvez Bobadilla, Manuel Alejandro; Parra Ruiz, Jorge; Ramos Sesma, Violeta; Velasco Fuentes, Sara; García Pereña, Laura; Lluna Carrascosa, Alfonso; Gilaberte Reyzábal, Sergio; Liébana Gómez, Mónica; Salillas Hernando, Juan; Serrano Martínez, Alberto; Torralba González de Suso, Miguel; Martínez Martín, Patricia; Rábago Lorite, Isabel; González-Ruano Pérez, Patricia; Pérez-Monte Mínguez, Beatriz; García Flores, Ángeles; Comas Casanova, Pere; Martín Plata, Andrea; Santana Báez, Sergio Manuel; Sanz Peláez, Oscar; Mohamed Ramírez, Karim; Robaina Bordón, José María; Vílchez Rueda, Helem Haydeé; Riera Jaume, Melchor; Mut Ramon, Gemma; Gavalda Manso, Meritxell; Planas Bibiloni, Lluis; Castelo Corral, Laura; Ramos Merino, Lucía; Sánchez Vidal, Efrén; Rodríguez Mayo, María; Míguez Rey, Enrique; García de Lomas Guerrero, José M.; De la Torre Lima, Javier; Correa Ruiz, Ana; Fernández Sánchez, Fernando; Jiménez-García, Nicolás; Sierra-Monzón, José Luis; Gracia-Tello, Borja; Hernández-Bonaga, María; Pellejero, Galadriel; Asín-Corrochano, Marta; Boix Palop, Lucia; Calbo, Esther; Badía, Cristina; Dietl, Beatriz; Lucía, Gómez; Domínguez-Castellano, Ángel; Ríos-Villegas, María José; del Toro, María D.; Palacios Baena, Zaira R.; Salamanca-Rivera, Elena;
Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters.A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001).Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.
Spain
Male, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies, Medical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones, Hospitalización, Estudios Retrospectivos, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Vital Statistics::Mortality, Adrenal Cortex Hormones, Intubación Intratraqueal, Hospital Mortality, Masculino, Ensure healthy lives and promote well-being for all at all ages, Persona de Mediana Edad, Adrenocortical hormones, Quimioterapia Combinada, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation, Femenino, General Medicine, Tocilizumab, Middle Aged, Humanos, Hospitalization, Infectious Diseases, Treatment Outcome, Original Article, Drug Therapy, Combination, Female, Cohort study, Microbiology (medical), Medicina, Mortalidad Hospitalaria, Resultado del Tratamiento, Hyperinflammatory state, Anciano, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections, http://metadata.un.org/sdg/3, Antibodies, Monoclonal, Humanized, Mortalitat, Intubation, Intratracheal, Corticosteroids, Humans, Mortality, Corticoesteroides, Aged, Proportional Hazards Models, Retrospective Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome, Inflammation, Inflamación, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Intubation::Intubation, Intratracheal, SARS-CoV-2, COVID-19, Anticuerpos Monoclonales Humanizados, Medical Subject Headings::Geographical Locations::Geographic Locations::Europe::Spain, Corticosteroides, COVID-19 Drug Treatment, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies, Spain, Monoclonal antibodies, Modelos de Riesgos Proporcionales, Medical Subject Headings::Organisms::Viruses::RNA Viruses::Nidovirales::Coronaviridae, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections::Severe Acute Respiratory Syndrome, Anticossos monoclonals, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Propensity Score
Male, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies, Medical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones, Hospitalización, Estudios Retrospectivos, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Vital Statistics::Mortality, Adrenal Cortex Hormones, Intubación Intratraqueal, Hospital Mortality, Masculino, Ensure healthy lives and promote well-being for all at all ages, Persona de Mediana Edad, Adrenocortical hormones, Quimioterapia Combinada, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation, Femenino, General Medicine, Tocilizumab, Middle Aged, Humanos, Hospitalization, Infectious Diseases, Treatment Outcome, Original Article, Drug Therapy, Combination, Female, Cohort study, Microbiology (medical), Medicina, Mortalidad Hospitalaria, Resultado del Tratamiento, Hyperinflammatory state, Anciano, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections, http://metadata.un.org/sdg/3, Antibodies, Monoclonal, Humanized, Mortalitat, Intubation, Intratracheal, Corticosteroids, Humans, Mortality, Corticoesteroides, Aged, Proportional Hazards Models, Retrospective Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome, Inflammation, Inflamación, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Intubation::Intubation, Intratracheal, SARS-CoV-2, COVID-19, Anticuerpos Monoclonales Humanizados, Medical Subject Headings::Geographical Locations::Geographic Locations::Europe::Spain, Corticosteroides, COVID-19 Drug Treatment, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies, Spain, Monoclonal antibodies, Modelos de Riesgos Proporcionales, Medical Subject Headings::Organisms::Viruses::RNA Viruses::Nidovirales::Coronaviridae, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections::Severe Acute Respiratory Syndrome, Anticossos monoclonals, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Propensity Score
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