Background and importance From the beginning of the COVID-19 pandemic, tocilizumab has been positioned as an effective drug to treat cytokine release syndrome, which causes acute respiratory distress in patients with SARS-CoV2 pneumonia. Throughout these months, clinical protocols have been developed that improve the effectiveness, introducing it at the onset of symptoms.
Aim and objectives To evaluate if the change in criteria for treatment with tocilizumab between the first and second waves of the COVID-19 pandemic, introducing it at the onset of symptoms, led to an improvement in its effectiveness.
Material and methods A retrospective observational study was conducted between 3 March 2020 and 15 October 2020 in patients with COVID-19 confirmed by PCR, treated with tocilizumab in a first level hospital. Demographic, clinical and pharmacotherapeutic data were collected from electronic medical records. To compare the effectiveness of treatment between the first COVID-19 wave (3 March to 31 May 2020) and the second COVID-19 wave (31 May to 15 October), we collected for each patient: days from admission to tocilizumab administration, oxygen therapy requirement, ICU stay, hospital stay and survival. Differences between quantitative and qualitative variables were analysed, applying the Student’s t test and the χ2 test (p≤0.005). Statistical analysis was performed with SPSS22.0.
Results 167 patients (131 men), average age 58.9±12.6 years, were included. During the first wave, tocilizumab was administered to 100 patients. Days (average) until administration was 5±4.4. Length of hospital stay was 22.9±15.9 days. 39.0% of patients needed a stay in the ICU. Distribution of patients according to requirement for oxygen therapy: 48% high flow (HF) oxygen delivery systems, 19% low flow (LF) oxygen delivery systems and 31% with invasive mechanical ventilation. Two patients did not require oxygen therapy. The mortality rate was 28%. During the second wave, tocilizumab was administered to 67. Days (average) until administration was 2±2.2. Length (average) of hospital admission was 13.1±10.4 days. 10.1% of patients needed a stay in the ICU. Distribution of patients according to requirement for oxygen therapy: 11.6% HF and 88.4% LF. The mortality rate was 11.6%. We found statistically significant differences in length of hospital stay and mortality rate between the two groups.
Conclusion and relevance The study showed that early administration of tocilizumab increased survival, decreased ICU income and shortened hospital stay. A limitation of our study was the lack of comparison between inflammatory parameters before and after administration. Further studies are needed.
Conflict of interest No conflict of interest
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