Tocilizumab Treatment for Hospitalized Patients with Severe Covid-19 Pneumonia: A Retrospective Case-Control Study

Abstract

Background: Tocilizumab, through the blocking of interleukin-6 receptors, is hypothesized to be effective in the treatment of severe coronavirus disease 2019 (COVID-19). However, data on tocilizumab use in this setting is conflicting. Objective: To evaluate the effect of tocilizumab treatment on the outcomes of patients with severe COVID-19 pneumonia. Methods: A retrospective case-control study including 168 patients hospitalized with severe COVID-19 pneumonia at Al-Jahra hospital, Kuwait, from April 1st to June 30th. All patients received standard of care treatment. Patients in the tocilizumab group received tocilizumab infusion. The primary outcomes were death, need for mechanical ventilation and the proportion of patients with clinical improvement. The incidence of adverse events was monitored. Results: Need for mechanical ventilation was higher in the tocilizumab group (48% vs. 24.3%, p=0.002). Clinical improvement was lower (54.1% vs. 71.4%) and number of deaths were higher (29.6% vs. 10%) in the tocilizumab group (p=0.009). There was no difference in the mean survival time between tocilizumab and control group (17.7 days vs. 19.2 days). There was no significant difference between the two groups regarding the incidence of infections (6.1% vs. 2.9%, p=0.471). Conclusion: Our results suggest that use of tocilizumab in severe COVID-19 pneumonia does not provide clinical or mortality benefit. However, further research is needed to determine the ideal utilization of tocilizumab in the setting of severe COVID-19 disease.