Background and importance Tocilizumab (TCZ) is an immunosuppressor drug, IL-6 inhibitor, indicated for the treatment of rheumatoid arthritis and cytokine release syndrome associated with CAR T cell therapy.
It was proposed as a compassionate treatment for severe COVID-19 due to its potential benefit as anticytokine therapy with IL-6 as the target, one of the most relevant cytokines involved in the cytokine storm induced by COVID-19.
Aim and objectives The main objective was to evaluate TCZ security and effectiveness in the treatment of COVID-19 pneumonia.
Material and methods A retrospective observational study was conducted in patients with COVID-19 pneumonia treated with TCZ from 20 March to 20 May 2020 at a tertiary hospital. Study variables were: age, sex, need for invasive and non-invasive ventilation, intubation days and oxygen therapy. Days in inpatient care, admission to intensive care units (ICU) and time spent there, adverse reactions and deaths were also obtained. Data were recollected from the electronic clinical records.
Results Data from 59 COVID-19 patients were collected in this study between March and May 2020. Median age (max-min) was 62.4 (48–74) years and 76.3% of patients were men. Comorbidities were: hypertension in 37.3%, dyslipidaemia in 20.3% and diabetes in 15.2%. Six patients had asthma and 5 had cardiopathy.
72 hours after TCZ administration, 54.2% of patients had respiratory improvement with a reduced need for oxygen therapy, 32.2% had stabilisation of their condition and 13.6% had worsening of their condition, requiring orotracheal intubation. Seven days after TCZ administration, 44 had clinical improvement with a reduced need for oxygen therapy, 6 remained stable with VNI and 9 had worsening of their condition (6 passed out, 3 were admitted to the ICU). TCZ was well tolerated with no adverse effects detected. 28 days after TCZ administration, mortality was 15.2%, 69.6% were discharged and 15.2% remained in hospital at the end of the study.
Conclusion and relevance The results of the study showed that TCZ was effective and safe in patients with COVID-19 pneumonia. Patient outcomes were favourable in most cases. During admission, patients showed clinical improvement with a reduced need for invasive ventilation and oxygen therapy. Due to the potential bias (patients received different treatments before and after TCZ) and the small sample size, it is necessary to confirm these results in controlled clinical trials.
Conflict of interest No conflict of interest
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