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Background: Several treatments have been utilized in the management of COVID-19 and only remdesivir is FDA-approved at this time. Tocilizumab is an interleukin-6 antagonist that has controversial data regarding its benefits in hospitalized COVID-19 patients. Remdesivir in addition to tocilizumab has not shown any additive benefit to date; however, randomized controlled trials are in process.The objective of this study was to assess the role of tocilizumab with or without remdesivir in reducing mortality and hospital length of stay in hospitalized patients with COVID-19. Methods:This retrospective, single centered, observational cohort study, included hospitalized patients with confirmed COVID-19 and clinically associated respiratory findings (infiltrates AND SPO2 < 93% or required respiratory assistance). Patients were excluded if they had a known hypersensitivity to tocilizumab or excipients, were pregnant or breastfeeding, had a known active infection (bacterial, TB, fungal or viral other than COVID-19), an AST/ALT greater than 5 times the upper limit of normal, an absolute neutrophil count of less than 500/mm3, a platelet count of less than 50,000 mm3, a documented history of bowel diverticulitis, perforation, or malignancy. Patients were evaluated based on clinical characteristics, pertinent laboratory data, and clinical outcomes. The primary endpoint was mortality at discharge and hospital length of stay. The secondary endpoint includes safety outcomes. The treatment groups compared standard of care plus tocilizumab versus standard of care plus tocilizumab and remdesivir. Standard of care included vitamin C, corticosteroids, and antibiotics.Results: 127 patients had data for analysis including 54 patients (group 1) that received standard of care plus tocilizumab and 73 patients (group 2) that received standard of care plus tocilizumab and remdesivir. Survival in group 1 was 83% compared to 81%in group 2, p = 0.7. Length of survival was not different by group when adjusted for those who recovered (24.3 vs. 30.4 days, p = 0.33). Length of stay for those who recovered was significantly different by group when adjusted for mortality (10.6 vs. 16.6 days, p = 0.01). Logistic regression revealed a higher mortality in patients age > 65 (RR 11, p = 0.003) and kidney insufficiency (RR 7.2, p = 0.004). Multivariate regression found an increased length of stay for patients with respiratory categories 2 or 3, p = 0.001. Conclusions:This study found no reduction in mortality and an increased length of stay in survivors attributed to standard of care plus tocilizumab and remdesivir when compared with standard of care plus tocilizumab.