Has become the management of severe SARS-CoV-2 infection a challenge for respiratory physicians?

Abstract

<b>Introduction:</b> No specific golden standard treatment has been proven to be effective in the treatment of patients with severe COVID-19 pneumonia. <b>Objectives:</b> The aim of this paper is to evaluate the efficacity and the potential benefit of remdesivir (R) versus remdesivir plus tocilizumab (RT) in severe COVID-19 pneumonia, by including the change in oxygen support, ICU admission, secondary bacterial infection, mortality rate, and the evolution of inflammatory biomarkers at 7 days after treatment. <b>Methods:</b> We conducted a retrospective, observational, longitudinal cohort study involving patients hospitalized for severe SARS-CoV-2 infection. The patients received R or RT depending on the type of oxygen requirement and on the inflammation markers (C-reactive protein, interleukin-6). <b>Results:</b> 100 patients received R and 82 RT. Patients treated with R evaluated at 7 days from baseline had a substantial improvement in Borg score (p=0.02), a better increase in lymphocytes count (p=0.03) and a decrease in oxygen requirement (p=0.049) compared to RT group. RT led to a significant decrease in the C-reactive protein and ferritin levels after 7 days of treatment (p=0.012 respectively p=0.004). However, patients treated with RT had a statistically significant higher rate of superinfection (p=0.04). There was not any statistical difference between the groups in the ICU admission or mortality rate (p=0.378, p=0.838). <b>Conclusion:</b> In this study including patients admitted to the hospital for severe COVID-19, R group had an improvement in symptomatology and RT led to a decrease in the inflammation markers but none of them have any potential benefit upon ICU admission and mortality at 7 days.