Efficacy of tocilizumab in the intensive care unit patients with COVID-19: a retrospective cohort study

Aim

To evaluate the efficacy of earlier and late tocilizumab (TCZ) infusion, that is, prior to and after initiation of mechanical ventilation, in reducing mortality in a cohort of patients with severe COVID-19 pneumonia who required support in the intensive care unit (ICU).

Material and methods

We conducted a retrospective cohort study in patients with severe COVID-19 pneumonia who were admitted to the ICUs across Russia between March 16 and May 5, 2020, for worsening oxygenation. All patients were treated with the standard of care, and a subset of patients also received intravenous TCZ. The primary endpoint of in-hospital all-cause mortality was compared between patients who received TCZ and those who did not using logistic regression model after adjustment for age and gender.

Results

159 of 328 patients (57.0% males, median age of 59 years) received at least one 400 mg flat dosing of TCZ. TCZ was administered to 83 (60.1%) of 137 patients who needed oxygen therapy or noninvasive ventilation (earlier TCZ cohort), and to 76 (39.8%) of 191 intubated patients (late TCZ cohort). Neither earlier nor late TCZ administration resulted in a lower risk of death compared to patients who did not receive TCZ infusion (age and gender adjusted odds ratios were 2.370, 95% CI 0.969-5,798; р=0.059, and 0.996, 95% CI 0.539-1.839; р=0.989, respectively).

Key words

COVID-19, pneumonia, ICU, tocilizumab, mortality.