Background and importance Tocilizumab is an immunosuppressive agent, an inhibitor of interleukin 6. In March 2020, it was included in the treatment plan of SARS-CoV-2 infection with the aim of slowing down the inflammatory phase. Therefore, tocilizumab constitutes a possible alternative therapy within the various experimental strategies available.
Aim and objectives To evaluate the effectiveness and safety of tocilizumab in patients with COVID-19.
Material and methods An observational retrospective study was conducted in every patient with COVID-19 treated with tocilizumab between March and August 2020. Demographic and clinical variables were collected from the electronic medical records: sex, age, diagnosis of pneumonia, dates of admission, discharge and administration of tocilizumab, and dose and treatment criteria. Analytical parameters related to disease severity (APRDS) were recorded: C reactive protein, ferritin, D-dimer and lactate dehydrogenase. Determination of interleukin 6 was not available at our hospital. To evaluate effectiveness, the clinical and analytical response after the administration of tocilizumab was recorded. Adverse effects were recorded to assess safety.
Results 50 patients were included (64% men), median age 68.53 years (range 25–89). All patients presented with pneumonia. Median length of hospital stay was 14 days (range 1–37). Treatment criteria were: rapid worsening of the disease in 50% of patients, 30% presented with criteria of severe systemic inflammatory response, 16% severe respiratory failure, 2% extrapulmonary organ failure and 2% of patients needed intensive care. 70% of patients had an increase in all of the APRDS, 24% in three parameters and 6% in two parameters. Meeting weight related dose criteria, 34 patients received tocilizumab 600 mg and 16 patients received 400 mg on the first administration. 13 patients received a second dose and one received a third for worsening APRDS. 53.10% obtained a good clinical–analytical response. In 38.8% there was no improvement, and the remaining 4 patients (8.1%) were transferred to another hospital before the response was assessed. No treatment related adverse effects were recorded.
Conclusion and relevance The results obtained in our population indicated that tocilizumab was well tolerated. With regards to the data on effectiveness, they showed unsatisfactory results. The available data on the use of tocilizumab in patients with COVID-19 are limited so it is important to carry out studies that allow global data to be collected.
Conflict of interest No conflict of interest