Evidence map›Paper›PMID 34436742›Full record

ArticleClinical and experimental nephrology2022

Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients.

Masataro Toda, Kentaro Fujii, Ayumi Yoshifuji, Yasushi Kondo, Kazuto Itoh, Kazuhiko Sekine, Takahide Kikuchi, Munekazu Ryuzaki

Open access · hybridAbstract read
In one paragraph

Article in Clinical and experimental nephrology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Masataro Toda *Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
Kentaro Fujii *Department of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
Ayumi YoshifujiDepartment of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan. ayutsuranaide@hotmail.com.ORCID http://orcid.org/0000-0001-8246-8675
Yasushi KondoDepartment of Rheumatology, Keio University School of Medicine, Tokyo, Japan.
Kazuto ItohDepartment of General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Kazuhiko SekineDepartment of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Takahide KikuchiDepartment of Hematology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Munekazu RyuzakiDepartment of Nephrology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
Saiseikai Central Hospital · JPKeio University · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCritical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ.

methodsFrom September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy.

resultsAmong non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p < 0.05), than the standard therapy group. All HD patients in the standard therapy group with oxygen demand exceeding 8 L/min died. Contrastingly, all patients in the TCZ + mPSL pulse group survived, with their oxygen demand decreasing to 0-1 L/min within 3 weeks post-administration.

conclusionTCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation.

Indexed as

COVID-19 Drug TreatmentRenal DialysisAdultAgedAged, 80 and overAntibodies, Monoclonal, HumanizedAnti-Inflammatory AgentsCOVID-19Cytokine Release SyndromeDrug Therapy, CombinationFemaleGlucocorticoidsHumansKidney DiseasesMaleMethylprednisoloneAntibodies, Monoclonal, HumanizedAnti-Inflammatory AgentsGlucocorticoidsMethylprednisolonetocilizumabCOVID-19Cytokine stormsHemodialysisSteroid pulse therapyTocilizumab

Identifiers

PMID34436742
PMCPMC8390024
OpenAlexW3194816250

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.