Ninety-day outcome of patients with severe COVID-19 treated with tocilizumab – a single centre cohort study

Abstract

OBJECTIVES Patients with severe COVID-19 may be at risk of longer term sequelae. Long-term clinical, immunological, pulmonary and radiological outcomes of patients treated with anti-inflammatory drugs are lacking. METHODS In this single-centre prospective cohort study, we assessed 90-day clinical, immunological, pulmonary and radiological outcomes of hospitalised patients with severe COVID-19 treated with tocilizumab from March 2020 to May 2020. Criteria for tocilizumab administration were oxygen saturation <93%, respiratory rate >30/min, C-reactive protein levels >75 mg/l, extensive area of ground-glass opacities or progression on computed tomography (CT). Descriptive analyses were performed using StataIC 16. RESULTS Between March 2020 and May 2020, 50 (27%) of 186 hospitalised patients had severe COVID-19 and were treated with tocilizumab. Of these, 52% were hospitalised on the intensive care unit (ICU) and 12% died. Eleven (22%) patients developed at least one microbiologically confirmed super-infection, of which 91% occurred on ICU. Median duration of hospitalisation was 15 days (interquartile range [IQR] 10–24) with 24 days (IQR 14–32) in ICU patients and 10 days (IQR 7–15) in non-ICU patients. At day 90, 41 of 44 survivors (93%) were outpatients. No long-term adverse events or late-onset infections were identified after acute hospital care. High SARS-CoV-2 antibody titres were found in all but one patient, who was pretreated with rituximab. Pulmonary function tests showed no obstructive patterns, but restrictive patterns in two (5.7%) and impaired diffusion capacities for carbon monoxide in 11 (31%) of 35 patients, which predominated in prior ICU patients. Twenty-one of 35 (60%) CT-scans at day 90 showed residual abnormalities, with similar distributions between prior ICU and non-ICU patients. CONCLUSIONS In this cohort of severe COVID-19 patients, no tocilizumab-related long-term adverse events or late-onset infections were identified. Although chest CT abnormalities were highly prevalent at day 90, the majority of patients showed normal lung function. Trial registration ClinicalTrials.gov NCT04351503

Characterization of pathogen‐inactivated COVID‐19 convalescent plasma and responses in transfused patients

“…Standard treatment for COVID‐19 consisted of hydroxychloroquine and lopinavir/ritonavir for those without a contraindication to these medications. Additionally, tocilizumab was applied in patients with hyperinflammation and remdesivir in those with oxygen desaturation 61 …”

“…Additionally, tocilizumab was applied in patients with hyperinflammation and remdesivir in those with oxygen desaturation. 61 …”

Exercise capacity impairment after COVID-19 pneumonia is mainly caused by deconditioning

“…Between February 26 and May 3, 2020, 221 patients with RT-PCR-confirmed SARS-CoV-2 infection were admitted to the University Hospital Basel, Switzerland. A total of 50 (22.6%) patients suffered from severe COVID-19 pneumonitis, fulfilling≥2 of the following criteria: respiratory rate>30·min −1 , SpO2<93% while breathing ambient air, C-reactive protein (CRP) levels>75 mg·L −1 (normal<10.0 mg·L −1 ), ground glass opacities or diffuse infiltrates on CT- scan or progression of>50% within 24–48 h or typical findings ≥ 4 lobes [ 4 ]. Patients were treated according to local standard at that time, and only one patient received systemic corticosteroids (cumulative dose of 80 mg prednisone); all patients were included in an observational study (NCT04351503).…”

Lung Ultrasound Is Useful for Evaluating Lung Damage in COVID-19 Patients Treated with Bamlanivimab and Etesevimab: A Single-Center Pilot Study

“…To our knowledge, no data on anti-COVID-19-specific mAb in lung recovery have been published so far. In addition, results on the lung recovery after modulation of inflammation using anti-cytokine mAb such as Tocilizumab are circumstantial [ 20 , 21 , 22 ].…”