Real-world experience with Tocilizumab for the treatment of COVID-19: a retrospective series of 314 patients

Abstract

Background: In December 2019, a novel coronavirus, SARS-CoV-2, caused an outbreak of pneumonia that spread worldwide triggering the worst pandemic in recent history. Some patients with COVID-19 developed a hyperinflammatory syndrome resulting in acute respiratory distress syndrome with high mortality. We report our experience with tocilizumab (TCZ) for the treatment of patients with acute respiratory failure in the context of COVID-19 severe pneumonia. Methods: We performed a retrospective study including the patients treated with Tocilizumab from March 11 to April 30 2020 in HM Hospitals in Madrid, Spain. Results: We identified 314 patients treated with TCZ in our institution. The mean age was 64.9 ± 12.4 (24.1 - 91.4) and most patients were male (79.1%). One week after TCZ infusion, 75% of patients had improved in terms of oxygen intake and 25.6% did not need further oxygen therapy. Prior to TCZ administration, most patients had elevated levels of CRP, ferritin and D-Dimer. CRP levels rapidly ameliorated after TCZ infusion. Median D-Dimer increased after TCZ, more importantly in non-survivor patients. Median duration of hospitalization was 13.5 days (range 2-96; IQR 10-22). Seventy-two patients (22.9%) died. Sixty-four patients (20.4%) were admitted to the Intensive Care Unit (ICU), twenty-six of which died. Conclusions: Tocilizumab seems to be effective decreasing inflammation parameters, improving the respiratory condition and reducing mortality of severe patients. Randomized clinical trials will provide further data to evaluate the effectiveness of this promising therapy.