Effects of Tocilizumab in Critically Ill Patients With COVID-19: A Quasi-Experimental Study

ObjectivesCritically ill patients with COVID-19 may suffer from a cytokine release syndrome (CRS) characterized by remarkably high levels of interleukin 6 (IL-6). We assessed the effects of tocilizumab, an IL-6 receptor antagonist, on intra-hospital mortality and development of positive cultures in patients with COVID-19 admitted to the ICU.DesignPatients with COVID 19 admitted in the ICU who were treated with tocilizumab plus standard care were enrolled and compared to controls.SettingCOVID-19 severe diseasePatientsPatients with severe COVID-19 disease admitted in the ICU.InterventionsTocilizumab 400 mg IV two doses. Standard and intensive medical care as per institutional clinical protocol.Measures and Main ResultsMain outcome: 1) intra-hospital mortality; Secondary Outcomes: 1) the need for renal replacement therapy, 2) use of antibiotics and positive culture, and 3) inflammatory and oxygenation markers. There was no difference in mortality, need for renal replacement therapy, use of antibiotics or positive cultures between the two groups. The use of corticosteroids was more frequent in the treatment group. Levels of C-reactive protein (CRP) and WBC (white blood cells) counts declined significantly faster in the treatment group. Oxygenation markers rose significantly higher in patients in the tocilizumab group as compared to controls.ConclusionTocilizumab was associated with rapid improvement in oxygenation and a faster decrease of CRP and WBC counts in patients with COVID-19 and should be evaluated as rescue therapy for patients with progressive disease