Tocilizumab Use In 44 Hospitalized Patient With Severe Covid-19 Pneumonia, A Single Centre Observational Study

Title: Tocilizumab Use In 44 Hospitalized Patient With Severe Covid-19 Pneumonia, A Single Centre Observational Study
Author(s): A.Qadeer, F.Bannon, A.Dimitrios, E.Dolan, L.Cormican
Institution: Connolly Hospital , Dublin 15
Poster: Click to view poster
Category: COVID 19
Coronavirus disease 2019 (COVID-19) is associated with a dysregulated immune response and hyperinflammation, a key mediator of which is cytokine IL-6. Tocilizumab (TCZ) a humanised anti-human IL-6 receptor monoclonal antibody, may be a possible adjunctive therapy in this context.
This is a single centre observational study of patients infected with COVID-19 who were treated with tocilizumab. 453 patients were admitted with covid 19 from the start of third surge of which 44 were identified for tocilizumab therapy by the following inclusion criteria: laboratory proven SARS-CoV-2 infection or high clinico-radiological suspicion of COVID-19 infection, CRS category C1, C2 and D, within 24 hours of starting nasal high flow (NHF) oxygen with an Fi02 of 0.6 or greater, (NIV) or invasive mechanical ventilation (IMV).
Data was collected from 44 patients who were severely ill with covid 19 infection and received tocilizumab. The study population consisted of 27 men (61.3%) and 17 women (38.6%) with a mean age of 63 years (range 35-86). The mean BMI was 36 kg/m2 (range 29-48). We had patients from different ethnicity included in our study group i.e., thirty-one (70.4%) were Caucasians, five (11.3%) were Asian, four (9.09%) Middle East and four (9.09%) Black. Among the comorbidities, eight patients (18%) had ischemic heart disease or arrythmia, five (11.3%) patients had history of diabetes and 11 patients (25%) had background hypertension only. However, twenty (45%) patients in our study group had no known comorbidities. The average Charlson comorbidity index (CCI) was 4. 11 (25%) patients progressed to intubation and in 33 (75%) patients oxygen requirement reduced. Thirty-seven (84%) patients were discharged, and seven (15.9%) patients died; thirteen out of thirty-seven patients needed admission to ICU. The SOFA score for all patients in our study group range in between 2 to 6. On average we noticed oxygen wean off time were thirteen days with range (4 to 26 days). There is significant improvement in PaO2/FiO2 ratio at every three-day interval observed post tocilizumab treatment. In addition, out of thirteen ICU admissions eight got discharged with average stay of 17-20 days in ICU and other five patients died. There had been only five (13.5%) patients in our study group who had secondary infection (fungal) post tocilizumab initiation which needed treatment with antifungal agents. Interestingly, we found C-reactive proteins (CRP) value for twenty patients (45%) in our study group improved to normal ranges in 3 to 5 days, further fifteen patients (34.1%) got CRP normalised in 8 days and remaining nine (20.4%) patients CRP took longer than 8 days reach normal range. However, seven out of these nine died.
This study supports the use of tocilizumab in critically ill COVID 19 patients (C1, C2 and D category on CRS) as it is safe, decreases progression of respiratory failure and had mortality benefits. CRP is a useful indicator of treatment response.