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严重 COVID-19 的调整剂量地塞米松和托珠单抗联合治疗。

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

机构信息

Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea.

出版信息

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

DOI:10.3349/ymj.2022.63.5.430
PMID:35512745
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9086692/
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 (=0.024). In multivariable analyses, peak FiO within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all <0.05). The DexaToci group showed a significantly steeper decrease in FiO (-4.2±2.6) than the Dexa group (-2.7±2.6; =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; =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.

摘要

目的

需要研究托珠单抗联合地塞米松治疗严重冠状病毒病（COVID-19）患者的真实世界经验。

材料和方法

回顾性队列研究评估了 2020 年 8 月至 2021 年 8 月严重 COVID-19 患者接受地塞米松调整剂量联合托珠单抗治疗的效果。主要终点为 30 天临床康复，定义为恢复后无需吸氧或转科。

结果

共评估 66 例患者，其中地塞米松（Dexa）组 33 例，地塞米松联合托珠单抗（DexaToci）组 33 例。DexaToci 组 30 天临床康复的效果显著优于 Dexa 组（=0.024）。多变量分析显示，3 天内的峰值 FiO 和托珠单抗联合治疗是 30 天康复的独立预测因素（均<0.05）。DexaToci 组的 FiO 下降速度（15 天-4.2±2.6）明显快于 Dexa 组（15 天-2.7±2.6；=0.021）。DexaToci 组的氧疗时间明显短于 Dexa 组（中位数 10.0 天 vs. 17.0 天；=0.006）。两组恢复期严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的感染并发症以及细胞和体液免疫反应无差异。

结论

严重 COVID-19 患者接受地塞米松调整剂量联合托珠单抗治疗可改善临床康复，不增加感染并发症，不抑制针对 SARS-CoV-2 的免疫反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/3ca33b452ce1/ymj-63-430-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/2e351b9a4770/ymj-63-430-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/117063be5fee/ymj-63-430-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/3ca33b452ce1/ymj-63-430-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/2e351b9a4770/ymj-63-430-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/117063be5fee/ymj-63-430-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4711/9086692/3ca33b452ce1/ymj-63-430-g003.jpg

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