Respiratory Research (Dec 2021)

Tocilizumab improves 28-day survival in hospitalized patients with severe COVID-19: an open label, prospective study

  • Theodoros Karampitsakos,
  • Elli Malakounidou,
  • Ourania Papaioannou,
  • Vasilina Dimakopoulou,
  • Eirini Zarkadi,
  • Matthaios Katsaras,
  • Panagiota Tsiri,
  • Georgios Tsirikos,
  • Vasiliki Georgiopoulou,
  • Ioanna Oikonomou,
  • Christos Davoulos,
  • Dimitrios Velissaris,
  • Fotios Sampsonas,
  • Markos Marangos,
  • Karolina Akinosoglou,
  • Argyris Tzouvelekis

DOI
https://doi.org/10.1186/s12931-021-01914-6
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 8

Abstract

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Abstract Background Data on the safety and efficacy profile of tocilizumab in patients with severe COVID-19 needs to be enriched. Methods In this open label, prospective study, we evaluated clinical outcomes in consecutive patients with COVID-19 and PaO2/FiO2 < 200 receiving tocilizumab plus usual care versus usual care alone. Tocilizumab was administered at the time point that PaO2/FiO2 < 200 was observed. The primary outcome was 28-day mortality. Secondary outcomes included time to discharge, change in PaO2/FiO2 at day 5 and change in WHO progression scale at day 10. Findings Overall, 114 patients were included in the analysis (tocilizumab plus usual care: 56, usual care: 58). Allocation to usual care was associated with significant increase in 28-day mortality compared to tocilizumab plus usual care [Cox proportional-hazards model: HR: 3.34, (95% CI: 1.21–9.30), (p = 0.02)]. There was not a statistically significant difference with regards to hospital discharge over the 28 day period for patients receiving tocilizumab compared to usual care [11.0 days (95% CI: 9.0 to 16.0) vs 14.0 days (95% CI: 10.0–24.0), HR: 1.32 (95% CI: 0.84–2.08), p = 0.21]. ΔPaO2/FiO2 at day 5 was significantly higher in the tocilizumab group compared to the usual care group [42.0 (95% CI: 23.0–84.7) vs 15.8 (95% CI: − 19.4–50.3), p = 0.03]. ΔWHO scale at day 10 was significantly lower in the tocilizumab group compared to the usual care group (-0.5 ± 2.1 vs 0.6 ± 2.6, p = 0.005). Conclusion Administration of tocilizumab, at the time point that PaO2/FiO2 < 200 was observed, improved survival and other clinical outcomes in hospitalized patients with severe COVID-19 irrespective of systemic inflammatory markers levels.

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