Tocilizumab in the treatment of critical COVID-19 pneumonia: A retrospective cohort study of mechanically ventilated patients

• Published in: International journal of infectious diseases Vol. 103; pp. 536 - 539
• Main Authors: Fisher, Matthew J., Marcos Raymundo, Luis A., Monteforte, Melinda, Taub, Erin M., Go, Roderick
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.02.2021; The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: Adult; Aged; Antibodies, Monoclonal, Humanized - therapeutic use; COVID-19; COVID-19 Drug Treatment; Cytokine release syndrome; Female; Humans; Male; Mechanical ventilation; Middle Aged; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Tocilizumab; COVID-19; Cytokine release syndrome; Tocilizumab; Mechanical ventilation
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.12.021

•Tocilizumab was not associated with significantly reduced mortality in mechanically ventilated patients with COVID-19 pneumonia.•Patients who received tocilizumab were younger, presented with higher fever on the day of intubation, and had significantly fewer comorbidities than controls.•Elevated interleukin-6 was associated with greater mortality risk; interleukin-6 levels were similar in the treatment and control group. The purpose of this study is to evaluate clinical outcomes in patients with critical COVID-19 pneumonia requiring invasive mechanical ventilation who were treated with tocilizumab Single-center retrospective cohort study Stony Brook University Hospital, a 600-bed academic tertiary medical center in Suffolk County, New York Consecutive patients with COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) who were admitted to Stony Brook University Hospital between March 10 and April 2 2020 and required mechanical ventilation in any intensive care unit during their hospitalization Treatment with tocilizumab while intubated Overall mortality 30 days from the date of intubation Forty-five patients received tocilizumab compared to seventy controls. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and sequential organ failure assessment (SOFA) scores were similar between the two cohorts. Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 vs 3.0,P = 0.01) than controls. There was a trend towards younger mean age in the tocilizumab exposed group (56.2 vs 60.6; P = 0.09). In logistic regression analysis there was no reduction in mortality associated with receipt of tocilizumab (odds ratio (OR) 1.04; 95% CI, 0.27–3.75). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 vs 25.7; OR 1.17; 95% CI, 0.51–2.71). When controlling for age, severity of illness, and co-morbidities, tocilizumab was not associated with reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine the role of tocilizumab in the treatment of COVID-19.