Abstract:
Introduction/objectives: An interleukin-6 inhibition strategy could be effective in
selected COVID-19 patients. The objective is to present our experience of tocilizumab
use in patients with severe COVID-19.
Methods: Observational retrospective cohort study. Hospitalized patients were
evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with
progressive ventilatory impairment and evidence of a hyperinflammatory state despite
usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg),
in addition to standard treatment. The use and time of use of mechanical ventilation
(MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen
partial pressure to fractional inspired oxygen (PaO2/FiO2) and of inflammation laboratory
parameters after 72 h of tocilizumab use was evaluated.
Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and
34.5% had hypertension. Of the 20 patients who were not on MV when receiving
tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them
required intubation. A-a gradient, PaO2/FiO2, and inflammation parameters improved
significantly. A better lymphocyte count, which improved significantly after tocilizumab
use, was significantly associated with less use of MV. Five patients presented positive
culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte
count was associated with having a positive culture. No other significant adverse events
were seen.
Conclusion: Our study suggests the utility and shows the safety of tocilizumab use
in COVID-19 patients who have respiratory failure and evidence of hyperinflammation.
Lymphocyte improvement was a predictor of good response.
