Tocilizumab reduces the need for mechanical ventilation in severe Coronavirus Disease 2019 (COVID19), the Greek Experience in a pragmatic clinical setting

ABSTRACT

Introduction: Severe COVID-19 can result in rapid clinical deterioration consistent with cytokine release syndrome leading to mechanical ventilation. Aim(s) To evaluate clinical outcomes in patients with severe COVID-19 pneumonia who were treated with Tocilizumab in an attempt to hinder their downfall to mechanical ventilation. Material(s) and Method(s) We reviewed consecutive inpatients with severe pneumonia secondary to COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) between March 2021 and December 2021 who presented with >50% lung infiltrates on chect CT scan, WHO score 6-8, pO2/FiO2<200. Result(s) 135 patients received Tocilizumab compared to 160 controls who received standard care. Baseline demographics, comorbidities, inflammatory markers, and corticosteroid treatment were similar between the two groups. Patients who received Tocilizumab had significantly lower intubation rates (6% vs 19%, P = 0.001) than controls and lower 60day mortality (3% versus 8.9%, p=0.02). Age range was similar in the Tocilizumab and control group. Importantly, there were no secondary infections observed in the Tocilizumab group. Conclusion(s) Administration of tocilizumab in carefully selected patients with severe COVID19 pneumonia hindered their downfall to intubation, decreased 60day mortality and improved clinical outcomes.