Elsevier

Journal of Autoimmunity

Volume 114, November 2020, 102523
Journal of Autoimmunity

Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study

https://doi.org/10.1016/j.jaut.2020.102523Get rights and content

Highlights

  • In severe COVID-19 pneumonia, use of tocilizumab (TCZ) was associated with low mortality, and no major safety concerns.

  • Early TCZ-response by BCRSS and low comorbidity were associated with increased survival.

  • An early tocilizumab response was related to shorter median hospital stay.

Abstract

Objectives

To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia.

Patients and methods

Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression.

Results

From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0–72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%).

Median follow-up was 83.0 days (78.0–86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01–0.68), p = 0.028), and Charlson index (OR 3.54 (1.20–10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0–23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay.

Conclusions

In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.

Keywords

COVID19 pneumonia
Tocilizumab
Mortality
Mechanical invasive ventilation
Case series

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1

These authors contributed to the manuscript equally and share first authorship.

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