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. 2020 Nov:114:102523.
doi: 10.1016/j.jaut.2020.102523. Epub 2020 Jul 16.

Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study

Oscar Moreno-Pérez  1 , Mariano Andres  2 , Jose-Manuel Leon-Ramirez  3 , José Sánchez-Payá  4 , Juan Carlos Rodríguez  5 , Rosario Sánchez  6 , Raquel García-Sevila  7 , Vicente Boix  8 , Joan Gil  9 , Esperanza Merino  10
Affiliations

Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study

Oscar Moreno-Pérez et al. J Autoimmun. 2020 Nov.

Abstract

Objectives: To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia.

Patients and methods: Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression.

Results: From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0-72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%). Median follow-up was 83.0 days (78.0-86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01-0.68), p = 0.028), and Charlson index (OR 3.54 (1.20-10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0-23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay.

Conclusions: In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.

Keywords: COVID19 pneumonia; Case series; Mechanical invasive ventilation; Mortality; Tocilizumab.

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Conflict of interest statement

MA declares speaking fees from Roche Pharma (<10,000$).

Figures

Fig. 1
Fig. 1
Predictors of In-Hospital Death from Multivariable Logistic-Regression Analysis. Figure legend. The 95% confidence intervals (CIs) of the odds ratios have been adjusted for multiple testing. 14 lost cases, 63 patients included in the analysis. R2 models: 0.62 for mortality. BCRSS respiratory score response to TCZ, defined as the absence of progression or improvement in the score 72 h after the infusion of TCZ.
Fig. 2
Fig. 2
Early clinical response to tocilizumab and length of hospital stay. Figure legend. Boxplot represents the degree of dispersion of the length of hospital stay, horizontal line denote the median. Length of hospital stay between responders a non-responders were compared by Mann-Whitney's U. BCRSS, Brescia COVID Respiratory Severity Scale.
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