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

Abstract

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.

Efficacy of the early treatment with tocilizumab-hydroxychloroquine and tocilizumab-remdesivir in severe COVID-19 Patients

“…In our study's findings, there was no significant difference between TCZ-HCQ and TCZ-RMV in both therapeutic failure and mortality rates which is indicating that both HCQ and RMV could be considered equally safe when used for treating severe COVID-19 patients. The mortality rate in both groups was comparable to many previous studies [ 18 , 27 ], higher than some reported rates of 4.3–11% [ 26 , 30 ], and lower than others reporting mortality of 60.5% [ 34 ], which is attributed to different patient characteristics [ 18 ]. On the other hand, other previous studies did not agree with the clinical efficacy of TCZ, RMV, and HCQ in the treatment of COVID-19 patients [ [35] , [36] , [37] ].…”

“…Both of them showed significant clinical improvement in CRP level and P/F ratio after completion of study doses with nearly similar LOS and mortality. It could be attributed to the significant therapeutic effects of TCZ which prove its superiority when combined with the standard management of moderate to severe COVID-19 cases as repeatedly reported in recent studies [ 18 , 22 ]. As a monoclonal antibody, it targets the IL-6 pathways to calm the inflammatory storm and decrease mortality [ 23 , 24 ].…”

“…The drug was tested in many clinical trials for severe SARS-CoV-2 cases and was found to improve many laboratory parameters including reduction of C-reactive protein (CRP), Interleukin (IL-6), lactate dehydrogenase (LDH), ferritin, and Total Leukocyte Count (TLC). Also, it reduces lung complications, duration of hospitalization, needs for ICU admission and mechanical ventilation, and mortality rate [ [17] , [18] , [19] ].…”

The role of IL-6 and IL-6 blockade in COVID-19

“…CoV-2 pandemic, IL-6 blockade using monoclonal antibodies was investigated with potential benefits described in several observational or cohort studies [105,127,131,[158][159][160][161]. However, some contrasting data from RCTs with the IL-6 R blocker tocilizumab have raised questions on the real usefulness of these drugs and posed some questions about the real role played by IL-6 in severe COVID-19 [10,139,140,142,143,162,163].…”

Highlights of clinical and laboratory parameters among severe COVID-19 patients treated with tocilizumab: a retrospective observational study

“…25 In another study, it was stated that use of tocilizumab in severe cases of COVID-19 was safe and had a positive effect regarding improvement of many laboratory parameters. 26 In a meta-analysis that examined the causal relationships between interventions and outcomes and included reference randomized controlled studies, it was stated that administering tocilizumab to patients who had been hospitalized due to COVID-19 did not reduce the risk of all-cause mortality in these patients, but it reduced the possibility of needing mechanical ventilation. 15 In our study, the mortality rate was 60.3%, but all the patients were diagnosed with severe COVID-19.…”