High-dose glucocorticoids followed by tocilizumab accelerates clinical improvement, reduces mortality and reduced the need for invasive mechanical ventilation (IMV), concludes a study published in the Annals of the Rheumatic Diseases.
From 1 April 2020, patients with COVID-19-associated cytokine storm syndrome (CSS), defined as rapid respiratory deterioration plus ≥2 of three biomarkers (C-reactive protein >100 mg/L; ferritin >900 µg/L; D-dimer >1500 µg/L), received high-dose intravenous methylprednisolone for five consecutive days (250 mg day 1, 80 mg days 2-5). If the respiratory condition had not improved, or was insufficient (43%), tocilizumab (8 mg/kg single infusion) was added on or after day 2.
The primary outcome was ≥2 stages of improvement on a seven-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital.
At baseline, all participants (172) had symptoms of CSS and faced acute respiratory failure. Treated patients had 79 per cent higher likelihood of reaching the primary outcome, 65 per cent less mortality and 71 per cent less invasive mechanical ventilation.
Presenting the findings, the authors said a strategy of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated CSS.