Tocilizumab is associated with reduced risk of ICU admission and mortality in patients with SARS-CoV-2 infection

Abstract

Background In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world, therefore, clinical strategies to avoid ICU admission are needed. Objective We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Methods A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P= 0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0∙1, P=0.0001) of ICU admission or death. Conclusions Tocilizumab in the early stages of the inflammatory flare, could avoid an important number of ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports.

Immunosuppressive Drugs and COVID-19: A Review

“…Lastly, three other studies report a higher 3-week survival rate ( Capra et al., 2020 ), a lower rate of mechanical ventilation ( Klopfenstein et al., 2020 ) and a lower rate of ICU admission ( Moreno-García et al., 2020 ) in patients treated with tocilizumab. Remarkably, in two of these studies, the tocilizumab-treated patients were more critically ill at admission than controls, but their outcome was better.…”

“…There is growing interest in IL-6 inhibitors, like tocilizumab. Patients with severe COVID-19 have high levels of IL-6 ( Mosharmovahed et al., 2020 ) and in three cohort studies, tocilizumab use was associated with lower mortality and ICU admission rate ( Capra et al., 2020 ; Klopfenstein et al., 2020 ; Moreno-García et al., 2020 ). However, other cohort studies report contradictory results ( Campochiaro et al., 2020 ; Colaneri et al., 2020 ; Della-Torre et al., 2020 ; Giacobbe et al., 2020 ; Quartuccio et al., 2020 ; Rojas-Marte et al., 2020 ).…”

Beneficial Effect of Corticosteroids in Preventing Mortality in Patients Receiving Tocilizumab to Treat Severe COVID-19 Illness

“…In this regard, recent real-world observational studies of high quality from Italy, Spain, France and the US, indicated that TCZ might reduce ICU admissions, mechanical ventilator use, and risk of death, when compared to control group only treated with SOC [15][16][17][18][19][20][21][22][23][24]. Moreover, Moreno-García et al [16] conclude that the beneficial effect of TCZ might be especially shown in the subset of severely-ill non-intubated COVID-19 patients at early stage of the systemic hyperinflammatory response. In this respect, the SRMA by Boregowda et al [14] found that there was no statistical difference in mortality between TCZ and SOC when steroids are used in the treatment of severe COVID-19 (n=12; pooled OR 0.76 [95% CI 0.47, 1.23; p=0.27).…”

“…Nowadays, there is an emerging number of additional observational studies of higher quality from Italy, Spain, France and the US, either recently published or registered in the medRxiv repository [15][16][17][18][19][20][21][22][23][24]. These studies mostly assessed the use of TCZ in the subset of severely-ill non-intubated COVID-19 patients and were compared to a control group.…”

Coronavirus disease-2019 (COVID-19): value of IL-6 inhibitors

“…E.MorenoGarcia et al [87] сопоставили результаты применения ТЦЗ у 77 пациентов с COVID-19 c ОРДС в сравнении с группой контроля (n = 94). Лечение ТЦЗ ассоциировалось со снижением потребности в переводе в ОИТ (10,3 % vs 27,6 %, р = 0,005), потребности в ИВЛ (0 % vs 13,8 %, р = 0,001), а также суммарного показателя (перевод в ОИТ и летальный исход) (ОШ -0,03, 95%-ный ДИ -0,007-0,100, р = 0,0001).…”