ABSTRACT
INTRODUCTION: Markedly elevated pro-inflammatory cytokines, including interleukin-6 (IL-6), are associated with severe COVID-19. Blocking inflammation may prevent disease progression. Tocilizumab is a monoclonal antibody that reduces inflammation by blocking the IL-6 receptor, potentially having an impact on improving outcomes in patients with COVID-19. The objective of this study was to evaluate the use of tocilizumab in critically ill patients with COVID-19. METHOD(S): This multicenter, retrospective study included adults admitted to an intensive care unit (ICU) with severe COVID-19 from June 2020 to November 2021. Patients were placed into two groups: those who received one dose of tocilizumab in addition to dexamethasone, and those who received dexamethasone alone. Patients were matched on age, sex, C-reactive protein (CRP) level, and time from symptom onset to hospitalization. The primary endpoint was hospital length of stay (LOS). Secondary endpoints were ICU LOS, in-hospital all-cause mortality, number of mechanically ventilated days, and incidence of secondary infections. RESULT(S): 120 patients were included (60 patients per group). The mean age was 57 years old, 60% were male, and the median time from symptom onset to hospitalization was 7 days. The median CRP level in the tocilizumab + dexamethasone group vs the dexamethasone group was 140.6 and 143 mg/L, respectively. The median hospital LOS was 11 days (IQR 8-17) in the tocilizumab + dexamethasone group vs 13 days (IQR 8 - 22.8) in the dexamethasone group. In-hospital all-cause mortality occurred in 17 patients (28%) in the tocilizumab + dexamethasone group vs 16 patients (26%) in the dexamethasone group. Of the 26 patients in the tocilizumab + dexamethasone group and 24 patients in the dexamethasone group that were mechanically ventilated, the median number of mechanically ventilated days was 10 (IQR 5 - 18.3) vs 10.5 (5 - 18.8), respectively. Secondary infections were similar in both groups. CONCLUSION(S): In this retrospective study evaluating tocilizumab in addition to dexamethasone for severe COVID-19 treated in the ICU, tocilizumab did not show a benefit in clinical outcomes. Given the size of the study and its limitations, these findings should be interpreted with caution and require confirmation by larger studies.