Comparative evaluation of tocilizumab versus high dose methylprednisolonetherapy in mild acute respiratory distress syndrome related to COVID-19pneumonia: a retrospective cohort study

Abstract

Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) .The underlying causes of severe COVID-19 are related to systemic inflammatory responses that can lead to lung damage. Tocilizumab and high-dose glucocorticoids are practically used in ARDS cases associated with COVID-19. Corticosteroids are inexpensive and easily available drugs compared to tocilizumab. There is no study comparing these two drugs, which are becoming widely used in treatment-unresponsive COVID-19 pneumonia.In this study, we wanted to compare the beneficial effects of tocilizumab and high-dose methylprednisolone therapy in mild acute respiratory dyspnea syndrome (ARDS) caused by COVID-19. The study included 152 patients who received two doses of tocilizumab 400 mg or pulsed methylprednisolone therapy (500 mg/day for three days) due to mild ARDS related to COVID-19 pneumonia. The two groups were compared in terms of age, gender, comorbid diseases, hospital stay, admission to intensive care unit, length of stay in the intensive care unit, intubation status, mortality, C-reactive protein (CRP) level, white blood cell (WBC) count, platelet, neutrophil, lymphocyte, ferritin and D-dimer levels. There was no statistically significant difference between the groups in gender, comorbid diseases, need for intubation, mortality and need for intensive care. There was no statistically significant difference between the groups inage, total length of hospital stay, length of stay in intensive care, CRP, WBC, platelet, neutrophil, lymphocyte counts, ferritin and D-dimer values. The average cost of tocilizumab therapy is $500-1000, while it is $30 in pulsed methylprednisolone treatment. The present study found that treatment with pulsed methylprednisolonewhich is cheap and easy to access can be a good alternative to tocilizumab therapy in mild ARDS related to COVID-19 pneumonia.

Keywords

• COVID-19
• Tocilizumab
• methylprednisolone

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