Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19open access
- Authors
- Hong, J.Y.[Hong, J.Y.]; Ko, J.-H.[Ko, J.-H.]; Yang, J.[Yang, J.]; Ha, S.[Ha, S.]; Nham, E.[Nham, E.]; Huh, K.[Huh, K.]; Cho, S.Y.[Cho, S.Y.]; Kang, C.-I.[Kang, C.-I.]; Chung, D.R.[Chung, D.R.]; Baek, J.Y.[Baek, J.Y.]; Sohn, Y.M.[Sohn, Y.M.]; Park, H.J.[Park, H.J.]; Lee, B.[Lee, B.]; Huh, H.J.[Huh, H.J.]; Kang, E.-S.[Kang, E.-S.]; Suh, G.Y.[Suh, G.Y.]; Chung, C.R.[Chung, C.R.]; Peck, K.R.[Peck, K.R.]
- Issue Date
- May-2022
- Publisher
- Yonsei University College of Medicine
- Keywords
- COVID-19; Dexamethasone; immune response; tocilizumab
- Citation
- Yonsei Medical Journal, v.63, no.5, pp.430 - 439
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- Yonsei Medical Journal
- Volume
- 63
- Number
- 5
- Start Page
- 430
- End Page
- 439
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/98877
- DOI
- 10.3349/ymj.2022.63.5.430
- ISSN
- 0513-5796
- Abstract
- Purpose: Real-world experience with tocilizumab in combination with dexamethasone in patients with severe coronavirus disease (COVID-19) needs to be investigated. Materials and Methods: 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. Results: 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 (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decrease in FiO2 (-4.2±2.6) than the Dexa group (−2.7±2.6; p=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; p=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. Conclusion: 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. © Yonsei University College of Medicine 2022.
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