Abstract
Background: Currently, the management of SARS-CoV-2 varies with no definitive clinical guidelines, as scientific evidence across the globe differs in therapeutic options. This study intended to provide some clarity to the insufficient data based on the role of monotherapy with tocilizumab (TCZ) and combination therapy with remdesivir (RDV) and TCZ among patients with SARS-CoV-2 infection in El Paso, Texas. We evaluated the use of each therapy in the presence of steroids as the standard of care.Methods: One hundred and fifty-four SARS-CoV-2-infected patients from four different medical centers in El Paso, Texas, were screened, with 113 eligible for this longitudinal comparative observational study (February 1, 2020 to October 31, 2020). Group 1 (80 patients) received TCZ in the first 24 hours following admission, then methylprednisolone for the next 72 hours and group 2 (33 patients) were given TCZ as detailed in the single therapy group, plus RDV within the first 24 hours. Mann Whitney U test assessed median differences in laboratory biomarkers and Bivariate Logistic Regression assessed the odds of risk. An observation is considered statistically significant when P-value is ≤0.05.Results: Patients in group 1 had a statistically significant lower odds for ventilation use than group 2 (OR=0.34, 95%CI=0.12-0.95, p=0.034), although no statistically significant difference in mortality outcomes was observed across groups (OR=0.43, 95%CI:0.13-1.39, p=0.269).Conclusions: We concluded that the use of TCZ in SARS-CoV-2-infected patients in El Paso, with or without RDV, reported no mortality benefit. However, some minimal/non-use of ventilation benefit was observed in group 1. Nonetheless, a randomized controlled trial study is recommended to ultimately determine the combination role of TCZ and RDV among this highly vulnerable group of patients.
Highlights
In late 2019, a novel coronavirus, known as severe acute respiratory distress syndrome (ARDS) coronavirus 2 (SARS-CoV-2), appeared in Wuhan, central China [1]
We concluded that the use of TCZ in SARS-CoV-2-infected patients in El Paso, with or without RDV, reported no mortality benefit
Some minimal/non-use of ventilation benefit was observed in group 1
Summary
In late 2019, a novel coronavirus, known as severe acute respiratory distress syndrome (ARDS) coronavirus 2 (SARS-CoV-2), appeared in Wuhan, central China [1]. The infection with the SARS-CoV-2 causes a respiratory disease that often leads to progressive viral pneumonia and ARDS. Since the recognition of early reported cases of SARS-CoV-2 in December, there have been significant implemented measures to control the spread of the virus and reduce the mortality rates. Remdesivir (RDV), a nucleotide analog prodrug that inhibits viral RNA polymerases, has demonstrated in vitro activity against SARS-CoV-2 [4,5]. RDV shortens the time to recovery of SARS-CoV-2 hospitalized individuals with increased oxygen requirement and was thought to have a positive influence on mortality outcomes and a good safety profile [4]. This study intended to provide some clarity to the insufficient data based on the role of monotherapy with tocilizumab (TCZ) and combination therapy with remdesivir (RDV) and TCZ among patients with SARS-CoV-2 infection in El Paso, Texas. We evaluated the use of each therapy in the presence of steroids as the standard of care
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