Tocilizumab fails survival benefit in severe Covid-19 – a retrospective cohort study (preprint)

ABSTRACT

Background: Anti IL-6 monoclonal antibody Tocilizumab has produced mixed results in clinical trials for effectiveness against COVID-19. We conducted a retrospective cohort study to compare outcomes at 28 days of a cohort of patients with severe Covid-19 treated with Tocilizumab and standard care, with those receiving standard care only. Methods In this record based retrospective cohort study, patients hospitalized with Covid-19 were classified into non-severe and severe disease as per institutional protocol. One cohort received Tocilizumab with standard care and the second cohort received only standard care. Few patients also received high dose steroids as ‘pulse’ steroids on initial clinical deterioration. Data was collected for the treatment given including oxygen interface, steroids, antimicrobials, duration of hospital stay in survivors, requirement of mechanical ventilation and day of intubation from symptom onset. Results There was statistically significant mortality in Tocilizumab cohort as compared to standard care alone (HR 2.43, 95%CI 1.54–3.89). The need for mechanical ventilation was more in Tocilizumab cohort (85% vs 18%, P-value