LAUSR

INTRODUCTION: Severely ill patients with COVID-19 pneumonia have been found to have an extensive cytokine mediated inflammatory response This has been demonstrated by elevated pro-inflammatory markers, including interleukin 6 (IL-6) Tocilizumab is an IL-6 antagonist that has been hypothesized to benefit patients with COVID-19 by reducing cytokine release We set out to evaluate outcomes of patients who received tocilizumab at our health system We also assessed the impact that the timing of tocilizumab administration and the presence or absence of corticosteroids had on patient outcomes METHODS: A retrospective analysis was conducted of patients diagnosed with COVID-19 who received tocilizumab between March 20, 2020 and June 10, 2020 Data collected included patient age, weight, gender, timing of tocilizumab administration, dose, concomitant therapies including corticosteroids, respiratory status at the time of tocilizumab administration, patient disposition, change in C-reactive protein, change in lactate dehydrogenase, change in liver function tests, need for renal replacement therapy, and the incidence of secondary infections RESULTS: Two-hundred-twelve patients received tocilizumab during the specified period Overall, as of June 17, 2020, 165 patients (77 8%) had been discharged from the hospital, 14 patients (6 6%) were still hospitalized, 3 of those patients required mechanical ventilation, and 33 patients (15 6%) had died Among the subset of patients who received tocilizumab within 24 hours of admission and received corticosteroids (n=97), 82 patients (84 5%) had been discharged from the hospital, 5 patients (5 2%) were still hospitalized, one of whom required mechanical ventilation, and 10 patients (10 3%) had died Of the 212 total patients who received tocilizumab, 12 patients (5 7%) required initiation of renal replacement therapy, 4 patients (1 9%) had new onset seizure activity, and 23 patients (10 8%) developed a secondary infection as evidenced by at least one positive culture following administration CONCLUSIONS: The early use of tocilizumab in combination with corticosteroids may improve outcomes in patients with COVID-19 pneumonia Further evaluation of this treatment strategy is needed to fully assess clinical benefit