Effectiveness of Tocilizumab in Patients with Severe or Critical Lung Involvement in COVID-19: A Retrospective Study

Abstract

Introduction: Acute lung injury is associated with dysfunctional immune response to SARS-CoV-2. This leads to CRS, which require immunomodulatory treatments aiming to limit the excessive production of cytokines. The literature so far indicates the effectiveness of tocilizumab in patients with COVID-19-associated pneumonia, but there is no clear evidence of its effectiveness in patients with at least 50% lung involvement; therefore, we aimed to bridge this gap in knowledge. Materials and methods: Longitudinal data for 4287 patients with confirmed COVID-19 infection were collected between 1st March 2020 and 16th of January 2022. In total, 182 cases with lung involvement >50% and biochemical indicators of cytokine release storm (Il-6 >100 pg/mL) were selected and analyzed using non-parametric statistics and multivariate Cox models. Results: Among the 182 included patients, 100 (55%) were treated with TCZ, while 82 (45%) did not receive TCZ. The groups were balanced regarding demographics, lung involvement and biochemical markers. Overall mortality in the group was 63.1%. Mortality in the TCZ group was 58.0% compared to 69.5% (n = 57) in the non-TCZ group (p = 0.023). In multivariate Cox proportional hazards models, intravenous administration of tocilizumab was associated with lower probability of ICU admission (HR: 0333 (CI: 0.159–0.700, p = 0.004)) and lower mortality (HR: 0.57306 (CI: 0.354–0.927, p = 0.023)). Conclusions: Tocilizumab is effective as a treatment in the most severely ill patients, in whom the level of lung involvement by the inflammatory process can exceed 50% with coexisting biochemical indices of cytokine storm (Il-6 > 100 pg/mL).

Improved survival in intensive care unit in severe COVID-19 associated with amantadine use - retrospective study

“…It is most likely related to the more severe general condition of patients treated with TCZ. To avoid a sample selection bias, as Tocilizumab has a proven therapeutic effect in the treatment of patients with COVID-19 in severe general condition and cytokine storm ( Chober et al, 2022 )( Biran et al, 2020 ), we have created additional analyzes to show the effectiveness of amantadine in treating patients in the context of the use of other immunomodulatory drugs. Survival benefit associated with amantadine was retained in this group.…”

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

“…Of this therapeutic arsenal, tocilizumab is the most studied drug in the setting of severe COVID-19. Most randomized clinical trials (RCTs) and observational studies show favourable evidence that tocilizumab, when added to standard therapy, significantly reduces both 30-day mortality and the need for IMV without causing serious adverse events [ 38 , 39 , 40 , 41 ]. The RECOVERY study, initiated in March 2020, is the RCT with the largest number of participants enrolled so far, to test potential treatments against COVID-19 [ 38 ].…”

Artificial neural network based prediction of the lung tissue involvement as an independent in‐hospital mortality and mechanical ventilation risk factor in COVID‐19

“…In the advanced stages of COVID-19, cytokine storm is one of the primary features associated with unfavorable survival outcomes. [4][5][6][7] Pneumonia and respiratory failure remain key COVID-19 complications, regardless of the infecting variant. 8,9 Radiological imaging techniques, including computed tomography (CT), allow for a thorough investigation of the type and volume of lung tissue involved in COVID-19.…”