Tocilizumab treatment for patients with Covid-19 pneumonia - a single centre observational study

Abstract

Background: Tocilizumab (TCZ) is an approved therapy for cytokine release syndrome and its role in COVID-19 treatment is still debatable.

Objective: To observe the characteristics and clinical outcome of the COVID-19 patients who received TCZ.

Methods: The observational retrospective study was conducted between May and July 2020, and it included all consecutive patients who received TCZ for moderate to severe COVID-19 pneumonia with clinical aggravation and persistent inflammation, despite corticotherapy for at least 3 days. We observed inflamation markers, lymphocytes, oxygen saturation in room air and clinical outcome.

Results: Among the 19 patients, 10 were women. Mean age was 56. The chest CT showed extended „ground glass” lesions (>50% of the parenchyma) in all patients. At the time we administrated TCZ, mean C Reactive Protein (CRP) was 156 mg/l, mean Interleukin 6 (IL6) was 167 pg/ml and mean oxygen saturation was 77.9%.

10 patients died. Compared to survivors, they had: mean age 58.7 vs. 53.2 years, mean CRP 162.3 vs. 150.8 mg/l, mean IL6 186.8 vs. 109.3 pg/ml, mean lymphocytes 692 vs. 1011/ml and mean oxygen saturation 75.9% vs. 85.5%.

CRP levels dropped dramatically after a week in all cases. IL6 spiked in the first 3 days in all patients then decreased continuosly only in the surviving ones. The follow up of the surviving patients showed no episode of infection post TCZ.

Conclusions: In our study TCZ administration was safe and reduced inflammation. The surviving patients were younger, with lower level of inflammation, less hypoxemia and lymphopenia. The selection of the patients to receive Tocilizumab could be a key for better outcome.