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ObjectivesThe evidence for tocilizumab in the treatment of COVID-19 is contradictory, with some clinical trials showing benefits in regard to progression to mechanical ventilation (MV) and/or mortality. The aim of this study is to evaluate in real clinical practice the effectiveness of tocilizumab in treating COVID-19 and to identify prognostic factors for patient outcomes. Methods This was an observational, retrospective study of COVID-19 patients treated with tocilizumab between March 2020 and February 2021 in a tertiary hospital. Variables were demographics, comorbidities, vital signs, analytical parameters, COVID-19 treatment, progression to MV, intensive care unit (ICU) admission, hospital stay, and mortality. Results A total of 685 patients (64.7% men, median 68 years) were included. Overall mortality was 23.4% (14.2% in the first 14 days post-tocilizumab) and 93.3% in patients with MV and/or in the ICU at 14 days posttocilizumab. In addition, 61.5% of discharges occurred during the same period. In patients who died, statistically significant differences were observed in the baseline analytical parameters of C-reactive protein (CRP), Ddimer and higher lactate dehydrogenase (LDH) (p<0.05). Conclusions In most patients the clinical results of tocilizumab were observed at 14 days postadministration and could benefit from earlier administration of treatment. Baseline levels of CRP, D-dimer and LDH could be prognostic factors for the evolution of the COVID-19 patient. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY⇒ This real-life study with a large number of patients without the patient selection restrictions of clinical trials allows us to describe the profile of patients who received tocilizumab and the clinical outcomes of real clinical practice in COVID-19.

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Results 71 patients (69% men) with mean age of 55.1 (50-65) years were evaluated. 34 patients (47.9%) had pluripathology and 39 (54.9%) had polypharmacy, with a mean of 9.3 (6-26) drugs/patient. 37 drugs with anticholinergic burden were identified in 20 (28.2%) patients, and 10 of them (50%) had more than one anticholinergic burden drug. The most common drugs involved were chlorpromazine (15.2%), clorazepate (12.1%), paroxetine (12.1%), alprazolam (12.1%) and trazodone (9.1%). A total of 67 interactions (16 non-ART medication/51 ART medication) were detected in 34 patients (47.9%) with a mean of 2 (1-6) interactions/patient. 49 (73.1%) were considered potential interactions and 18 (26.9%) were not coadministered. 73 PI were performed in 40 patients (56.3%) with a mean of 1.8 (1-5) PI/patient. The main drug classes that were candidates for deprescription were: anxiolytics/sedatives (20.5%), antiulcers (13.7%), antipsychotics (9.6%), antidepressants (8.2%) and antidiabetics (8.2%). Conclusion and relevance About half of the patients had pluripathology and polypharmacy. Pharmacotherapeutic complexity was mainly due to the number of interactions. Considering the high number of drugs identified as candidates for optimisation, more coordinated intervention would be needed to improve pharmacotherapeutic prescriptions in the HIV population.