Tocilizumab for treatment of patients with severe COVID–19: A retrospective cohort study
Tariq Kewan, Fahrettin Covut, Mohammed Al‐Jaghbeer, Lori Rose, K V Gopalakrishna, Bassel Akbik
Abstract
Background: Tocilizumab was approved for chimeric antigen receptor Tcell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID19 patients. Methods: In this retrospective cohort study, we analyzed hypoxic COVID19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients. Findings: Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 625 975 days) vs. 13 days (IQR: 975 1525 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 183, 95% confidence interval [CI]: 057 584) and 65 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 114, 95% CI: 055 238), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 175 425 days) vs. 5 days (IQR: 4 8 days), p = 0.039, and 7 days (IQR: 4 14 days) vs. 10 days (IQR: 5 15 days) in tocilizumab vs. no tocilizumab cohorts, p = 0.11, respectively. Similar rates of hospitalacquired infections occurred in both cohorts (18% in tocilizumab and 22% in no tocilizumab cohort). Interpretation: In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID19 patients.