Introduction While there are no pharmacological treatments with proven efficacy for coronavirus disease 2019 (COVID-19), tocilizumab has emerged as a candidate therapy. Some aspects of this therapy are still unknown, including the optimal timing of administration. Objective This observational study aimed to compare the 90-day mortality in two cohorts of patients when the drug was administered within the first 10 days from onset of symptoms or after day 11. Methods Patients hospitalised with severe COVID-19 pneumonia who had received tocilizumab were divided into two groups according to when the medication was administered. The primary outcome was 90-day mortality. Secondary outcomes were 30-day mortality, clinical improvement on a 6-item scale by day 6, biomarker improvement by day 6, radiological image improvement by day 10 and SaO 2 quotient by day 6. The results in the two groups were compared. Additionally, adverse events relating to tocilizumab were recorded. Results A total of 112 patients were analysed. Both groups were epidemiologically comparable. The results obtained in the primary efficacy variable of the study (90day mortality) showed a statistically significant difference in the subgroups according to the time of administration of tocilizumab (18.6% vs 5.0%, p=0.048). There was clinical improvement in 24.1% of patients at 6 days, with similar behaviour in both subgroups. No statistically significant differences were found in the percentage of patients who achieved radiological improvement at 10 days or in the other inflammatory parameters, with the exception of significant reductions in lactate dehydrogenase and C-reactive protein. Administration of tocilizumab was not associated with relevant adverse events. Conclusion To our knowledge, this is the first report of data regarding the timing of administration of tocilizumab in patients with COVID-19 pneumonia. A strategy involving tocilizumab administration after 10 days from onset of symptoms may decrease mortality. Further randomised controlled trials are needed to confirm this emerging hypothesis.

Introduction On January 30th of 2020, the WHO declared the COVID-19 outbreak a health emergency. In Colombia the first case was reported on March 6th of 2020. The disease has unfavorable outcomes and mortality in patients with high risk factors like solid-organ transplant recipients. In Colombia the data of the behavior disease in liver transplant patients are limited. Objectives To describe the prevalence, need of admission to hospital, complications and mortality of COVID-19 in liver transplant recipients. Methods A descriptive study of case series was performed from March 1st of 2020 to January 31 st of 2021 in liver transplant recipients at Fundación Cardioinfantil-IC in Bogotá, Colombia. An analysis of clinical variables, severity laboratories, imaging and clinical follow-up were performed. Qualitative variables were described in percentage and quantitative variables were applied to a normality test using Kolmogorov Smirnov and Shapiro Wilk and the results were expressed as medians and IRQ or means and SD. Results Out of 540 adults liver transplant recipients on Fundación Cardioinfantil-IC, 34 patients (6.2%) were diagnosed with Covid 19, median age 62 years (IQR: 26), 20 (58%) male, 13 (38.2%) were admitted to hospitalization, and 4 (11.7%) required ICU. More frequent symptoms were fever in 17/34 patients (50%), cough in 17/34 (50%) and dyspnea 10/34 (29.4%). Ten patients (29.4%) had pneumonia as radiographic findings. Four patients required mechanical ventilation. Complications like acute renal injury were found in 3 patients, 1 patient required renal replacement therapy and 1 patient had gastrointestinal bleeding. 3 patients died (8.8%) on average 14 days of hospital length in ICU. Conclusion Although the group of liver transplant patients is considered to be at high risk for unfavorable outcomes in SARS COV2 infection, the data on mortality and complications were similar to the few data described in the literature.