J Med Virol. 2020 Aug 29. doi: 10.1002/jmv.26471. Online ahead of print.
BACKGROUND: We sought to evaluate the effect of Tocilizumab (TCB), a recombinant humanized monoclonal antibody against soluble interleukin-6 receptors, in patients hospitalized for coronavirus disease 2019 (COVID-19).
METHODS: We included all patients with laboratory confirmed COVID-19 who had completed hospitalization between March 10, 2020 and April 10, 2020 with follow up through April 20, 2020. Patients who received TCB in addition to standard of care within 48 hours of admission were matched in a 1:2 fashion to a similar cohort who received standard of care alone. Clinical outcomes were compared between matched groups. The primary outcome was de-escalation in oxygen therapy. Secondary outcomes were in-hospital death, septic shock, and acute kidney injury (AKI) requiring hemodialysis.
RESULTS: Out of 77 patients who received TCB in addition to standard of care, 34% (n=26) received TCB within 48 hours of admission. One-to-two propensity matching identified 20 vs. 40 patients in the TCB and no-TCB treatment arms. In the TCB group, an improvement in oxygenation was observed in 80% (n=16) of the patients by7 days post TCB administration. After matching, there was no difference in clinical outcomes between TCB and no-TCB patients. In-hospital death: 10% vs. 8%; p=0.823, Septic Shock: 10% vs 11%, p=0.912, AKI requiring hemodialysis (10% vs. 13%; p=0.734).
CONCLUSIONS: Early treatment with TCB in patients admitted for COVID -19 led to an improvement in their oxygen status during hospitalization. This change however did not translate into improved survival when compared to a matched cohort with a similar clinical profile. This article is protected by copyright. All rights reserved.