Efficacy of tocilizumab in the intensive care unit patients with COVID-19: a retrospective cohort study
Aim. To evaluate the efficacy of earlier and late tocilizumab (TCZ) infusion, that is, prior to and after initiation of mechanical ventilation, in reducing mortality in a cohort of patients with severe COVID-19 pneumonia who required support in the intensive care unit (ICU).Material and methods. We conducted a retrospective cohort study in patients with severe COVID-19 pneumonia who were admitted to the ICUs across Russia between March16 and May 5, 2020, for worsening oxygenation. All patients were treated with the standard of care, and a subset of patients also received intravenous TCZ. The primary endpoint of in-hospital all-cause mortality was compared between patients who received TCZ and those who did not using logistic regression model after adjustment for age and gender.Results. 159 of 328 patients (57.0% males, median age of59 years) received at least one 400 mg flat dosing of TCZ.TCZ was administered to 83 (60.1%) of 137 patients whoneeded oxygen therapy or noninvasive ventilation (earlier TCZcohort), and to 76 (39.8%) of 191 intubated patients (lateTCZ cohort). Neither earlier nor late TCZ administrationresulted in a lower risk of death compared to patients who didnot receive TCZ infusion (age and gender adjusted oddsratios were 2.370, 95% CI 0.969-5,798; р=0.059, and 0.996,95% CI 0.539-1.839; р=0.989, respectively).Conclusion. Earlier TCZ administration in non-intubated ICU patients with severe COVID-19 associated pneumonia or late infusion after initiation of mechanical ventilation were not associated with a reduction in all-case mortality.