Therapeutic efficacy, mechanical ventilation, length of hospital stay, and mortality rate in severe COVID‐19 patients treated with tocilizumab

Sarhan, Rania M; Madney, Yasmin M.; Abou Warda, Ahmed E.; Boshra, Marian S.

BACKGROUND: The treatment of severe cases of COVID‐19 disease remains a dilemma so far, because there is no approved therapy for it. This study aimed to estimate the therapeutic efficacy of tocilizumab and its role in reducing the need for mechanical ventilation, length of hospital stay, mortality rate for these cases. METHOD: The study included 25 adult patients with confirmed severe COVID‐19 infection. Treatment of all patients followed Egyptian Ministry of Health COVID‐19 protocol in addition to tocilizumab IV (400‐800 mg) as a single dose and then the dose was repeated after at least 12 hours and up to 24 hours from the previous dose. All laboratory and clinical parameters were assessed before and within 24 hours after tocilizumab administration. RESULTS: After receiving TCZ, all patients showed significantly lower median IL 6, LDH, CRP, ferritin , TLC at P < .001, and D‐Dimer at P = .223 than their baseline levels. Also, the number of patients who required mechanical ventilation decreased from 11 to 8. Only five patients died after TCZ treatment. A moderate correlation was found between therapeutic failure and death outcomes and mechanical ventilation need at baseline. The median days of hospitalisation (IQR) were 10 (6‐16). CONCLUSION: Tocilizumab treatment in patients with severe COVID‐19 is safe and has significant therapeutic effects and a significant role in the improvement of all laboratory parameters. Also TCZ plays a significant role in the reduction of the length of stay in hospital and ICU, need for mechanical ventilation, and mortality rate. WHAT’S KNOWN: IL‐6 plays the main role in the acute respiratory distress syndrome (ARDS) associated with severe COVID‐19 infection. Consequently, serum IL‐6 can be considered as an important target in therapeutic management of severe COVID‐19 patients. WHAT’S NEW: Prospective study, carried on 25 adult patients with confirmed severe COVID‐19 infection using tocilizumab, showed significant improvement in their case. Tocilizumab, as an IL‐6 inhibitor, not only lowered IL‐6 level put also showed a significant reduction on median LDH, CRP, ferritin , TLC at P < .001 and D‐Dimer at P = .223 than their baseline levels. Improvement of all laboratory parameters using TCZ was reflected in the reduction of the length of stay in hospital and ICU, need for mechanical ventilation and mortality rate.