Evaluation of hospitalized Covid-19 patients who received tocilizumab treatment in terms of clinical response, prognosis, and side effects

Abstract

Aim: In this study, we aimed to evaluate the clinical response, prognosis, and side effects of tocilizumab treatment among moderate, severe, and critical patients hospitalized due to coronavirus disease 2019 pneumonia. Materials and methods: Retrospectively, 48 adult patients were included. Age, gender, co-morbid conditions, chest CT findings, and treatment modalities were recorded, and laboratory findings and the necessity of oxygen on the first, third and seventh day of tocilizumab were evaluated. Results: While receiving tocilizumab, 34 (70.8%) of the patients were hospitalized in the intensive care unit, and 14 (29.1%) were in an inpatient clinic. On the seventh day, mean lymphocyte counts, mean C- reactive levels, and oxygen saturations were improved significantly (p: <0.001). All 14 patients whose tocilizumab treatment was initiated in an inpatient clinic survived, and none of them had needed an intensive care unit admission. The overall mortality rate was 45.8% (22/48). The average day of death was 16.6±12.6 (6 to 53). Among patients whose tocilizumab treatment was started in an intensive care unit, the mortality rate was 64.7% (22/34). Factors that were found to be significantly associated with mortality were as; hospitalization in an intensive care unit while receiving tocilizumab, receiving non-invasive/invasive mechanical ventilation, having bacterial superinfection, and high involvement in CT imaging (> 50%) at presentation. No serious side effects were observed during/after tocilizumab treatment. Conclusions: In patients with moderate disease who have clinical signs of deterioration, starting early tocilizumab treatment may prevent admission to intensive care, reduce the necessity for supplemental oxygen, and improve clinical and laboratory response. Keywords: SARS-CoV-2, tocilizumab, mortality