Assessment of The Effect of Tocilizumab in Adult Hospitalized COVID-19 Pneumonia Patients: A Clinical Trial

Abstract

ackground: Coronavirus disease 2019 (COVID-19) is a life-threatening infectious disease causing potentially severe acute respiratory infection which may lead to multi-organ dysfunction or failure due to severe acute respiratory syndrome coronavirus (SARS-CoV-2) also known as novel coronavirus (nCoV). Tocilizumab is anti-interleukin-6 receptor antibody may have potential role in minimizing mortality and mechanical ventilation requirements among hospitalized COVID-19 patients. Objective: To analyze the effect of tocilizumab in adult hospitalized COVID-19 pneumonia patients. Methods: This non-randomized, controlled, open-label trial was carried out at a tertiary care hospital, Sylhet, Bangladesh. Hospitalized COVID-19 pneumonia patients with hypoxia ( oxygen saturation < 92% on air or required oxygen) and proof of systemic inflammation(C-reactive protein ≥50mg/L) were assigned (in 1:1 ratio) to receive a standard care plus single dose of tocilizumab (8mg/kg up to a maximum of 800mg) or only standard care, who were not provided mechanical ventilation. Primary outcomes were 28-day mortality and necessity of mechanical ventilation. Results: The mean age was 59.08±12.39 years in tocilizumab group and mean age was 55.41±12.82 years in control group. Maximum patients were >60 years. The most common symptoms were fever (44.4%) then cough (38.9%), and others including diarrhoea, fatigue (33.3%). Majority risk factors were DM (47.7%) followed by HTN (30.5%). Mortality was more in control group than tocilizumab group which was 83.3% and 44.4% respectively. It is also observed that tocilizumab group patients needed mechanical ventilation significantly lower than the control group which was 19.4% and 44.4% respectively. The difference was statistically remarkable between the two groups (P<0.05). Conclusion: This study shows that hospitalized COVID-19 patients who were not receiving mechanical ventilation,tocilizumab increased survival rate and reduced the need of mechanical ventilation.