TOCILIZUMAB USE IN SEVERE COVID-19: A SINGLE CENTER EXPERIENCE

ABSTRACT

SESSION TITLE Critical Care Posters SESSION TYPE Original Investigation Posters PRESENTED ON October 18-21, 2020 PURPOSE: Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a novel virus that causes coronavirus disease 2019 (COVID-19). Previous studies have detected high levels of pro-inflammatory cytokines in COVID-19 patients, including interleukin-6 (IL-6). Tocilizumab is a humanized monoclonal antibody against IL-6 receptors and has been identified as a potential therapeutic agent for COVID-19. We aim to describe the treatment response of critically ill COVID-19 patients who received tocilizumab. METHODS: Following institutional review board approval, we identified 67 critically ill patients with laboratory confirmed COVID-19 infection who received tocilizumab. Decisions regarding clinical management, including tocilizumab administration, were made solely at the discretion of the treating provider. De-identified patient data was retrospectively collected and analyzed using Stata version 15.1 (StatCorp). Data reported in this study are those which are available through April 25 2020. RESULTS: We identified 67 critically ill patients with COVID-19 who were given tocilizumab (mean age 57 years (53-61), 71% male). At the time of tocilizumab administration, 42 patients required invasive mechanical ventilation, 11 required non-invasive mechanical ventilation, 11 required high flow nasal cannula and 3 patients required non rebreather mask or nasal cannula oxygen support. Three days after tocilizumab administration, 53 patients had no change in oxygen support requirements, 13 patients had reduced oxygen support requirements, and 2 patients required higher levels of oxygen support. For patients who remained on mechanical ventilation, there was a decrease in mean FIO2 requirement by 8.98%. There was a significant decrease in mean IL-6 by 129, CRP by 63, WBC by 1.71. Seven days after tocilizumab administration, 39 patients had no change in oxygen support requirements, 27 patients had reduced oxygen support requirements and 1 patient required higher levels of oxygen support. For patients who required mechanical ventilation, there was a decrease in mean FIO2 requirement by 13.36%. There was a significant decrease in mean IL-6 by 130, CRP by 107, WBC level by 2.87. There was no significant change in daily max temperature at day 3 or 7. CONCLUSIONS: In this cohort of 67 patients treated with tocilizumab for severe COVID-19, improvement in oxygen support requirements was seen in 13 patients at day 3 and 27 patients at day 7. Improvement in FIO2 and several markers of inflammation including WBC, CRP and IL-6 were seen at day 3 and 7. Further studies such as randomized placebo controlled trials of tocilizumab will be required to better measure its efficacy and safety in patients with COVID-19. CLINICAL IMPLICATIONS Tocilizumab use in critically ill patients may reduce oxygen support requirements and laboratory markers of inflammation. Further studies are required to establish efficacy and safety. DISCLOSURES No relevant relationships by Yasmin Herrera, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Joseph Poon, source=Web Response