Efficacy of tocilizumab in treatment of COVID-19 pneumonia: A case-control study from a tertiary care hospital.

Abstract

Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome virus, which has affected billions of people across the globe. The pathogenesis of respiratory inflammation involves elevated concentration of interleukin-6; hence, interventions targeting interleukin-6 receptor, such as tocilizumab (TCZ), have been investigated as potential treatment amidst the dilemma of COVID-19 management. The aim of the study is to analyse the efficacy and safety of TCZ and record the outcome in COVID-19 patients. A retrospective case-control study of 80 patients in each group (N = 160) was carried out in a tertiary care hospital in Vadodara, Gujarat. Non-pregnant COVID-19-positive patients above 12 years of age were included in the study and were divided into case (those given TCZ) and control (those given standard treatment) groups after collecting their history and related data. From each group, further data was collected in the form of general and systemic examination, investigations and calculation of inflammatory and Sequential Organ Failure Assessment (SOFA) scores. Overall mortality was less in the case group compared to the control group. Patients with moderate to severe disease, age <55 years, patients having no comorbidity and patients with higher oxygen demand had lower deaths when given TCZ. Inflammatory score <3 and SOFA score <6 were associated with reduced mortality in the case group. Additionally, the study found significant results by simultaneously analysing two parameters in combination, which has not been done in any other study to the best of our knowledge. Adjuvant TCZ therapy had overall mortality benefit compared to standard treatment, with specific benefit observed in those with increasing disease severity, young to middle-age group, absence of comorbidity, higher oxygen requirements and lower inflammatory and SOFA scores.