Yonsei Med J.  2022 May;63(5):430-439. 10.3349/ymj.2022.63.5.430.

Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19

• Hong JY
• Ko JH
• Yang J
• Ha S
• Nham E
• Huh K
• Cho SY
• Kang CI
• Chung DR
• Baek JY
• Sohn YM
• Park HJ
• Lee B
• Huh HJ
• Kang ES
• Suh GY
• Chung CR
• Peck KR

• KMID: 2529388
• DOI: http://doi.org/10.3349/ymj.2022.63.5.430

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.

Keyword

Dexamethasone; tocilizumab; COVID-19; immune response