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Comparing Efficacy and Safety of Tocilizumab and Methylprednisolone in the Treatment of Patients With Severe Covid-19 Publisher Pubmed



Abbasian L1 ; Toroghi N2 ; Rahmani H3 ; Khalili H3 ; Hasannezhad M4 ; Ghiasvand F4 ; Jafari S4 ; Salehi M4 ; Salahshour F5 ; Azadbakhsh Kanaf Gorabi M4 ; Alizade F4 ; Ghaderkhani S4 ; Nakhostin M4
Authors
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Authors Affiliations
  1. 1. Department of Infectious Diseases, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran

Source: International Immunopharmacology Published:2022


Abstract

Objectives: This study was designed to compare the efficacy and safety of methylprednisolone and tocilizumab in the treatment of patients with severe COVID-19. Methods: During a prospective cohort study, hospitalized patients with severe COVID-19 received intravenous methylprednisolone (250–500 mg daily up to three doses), weight-based tocilizumab (maximum 800 mg, one or two doses as daily interval) or dexamethasone (8 mg daily). The primary outcome was time to onset of clinical response. Secondary outcomes were improvement rate of oxygen saturation and CRP, need for ICU admission, duration of hospitalization and 28-day mortality. During study, adverse events of the treatments were recorded. Results: Although the difference was not statistically significant (p = 0.090), clinical response occurred faster in the tocilizumab group than other groups (10 vs. 16 days). Clinical response was detected in 74.19%, 81.25%, and 60% of patients in the methylprednisolone, tocilizumab, and dexamethasone groups respectively (p = 0.238). Based on the Cox regression analysis and considering dexamethasone as the reference group, HR (95% CI) of clinical response was 1.08 (0.65–1.79) and 1.46 (0.89–2.39) in the methylprednisolone and tocilizumab groups respectively. Improvement rate of oxygen saturation and CRP was not significantly different between the groups (p = 0.791 and p = 0.372 respectively). Also need for ICU admission and 28-day mortality was comparable between the groups (p = 0.176 and p = 0.143 respectively). Compared with methylprednisolone, tocilizumab caused more sleep disturbances (p = 0.019). Other adverse events were comparable among patients in the groups. Conclusion: When or where access to tocilizumab is a problem, methylprednisolone may be considered as an alternative for the treatment of patients with severe COVID-19 © 2022 Elsevier B.V.