Tocilizumab as a Therapeutic Agent for Critically Ill Patients Infected with SARS-CoV-2

Russell Petrak, Nathan Skorodin, Nicholas Van Hise, Robert Fliegelman, Jonathan Pinsky, Vishal Didwania, Michael Anderson, Melina Diaz, Kairav Shah, Vishnu Chundi, David Hines, Brian Harting, Kamo Sidwha, Brian Yu, Paul Brune, Anjum Owaisi, David Beezhold, Joseph Kent, Dana Vais, Alice Han, Neethi Gowda, Nishi Sahgal, Jan Silverman, Jonathan Stake, Jenie Nepomuceno, Renuka Heddurshetti   

Abstract

Background: Tocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2. Methods: We evaluated patients treated with tocilizumab for a SARS-CoV-2 infection who were admitted between 3/13/20 and 4/16/20. This was a multi-center study with data collected by chart review both retrospectively and concurrently. Parameters evaluated included age, sex, race, use of mechanical ventilation (MV), usage of steroids and vasopressors, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. In the absence of mechanical ventilation, the timing of the dose was related to the patient’s date of admission only.

Results: We evaluated 145 patients. The average age was 58.1 years, 64% were male, 68.3% had comorbidities, and 60% received steroid therapy. Disposition of patients was 48.3% discharged and 29.3% expired, of which 43.9% were African American. Mechanical ventilation was required in 55.9%, of which 34.5% expired. Avoidance of MV (p value = 0.002) and increased survival (p value < 0.001) was statistically associated with early dosing. Conclusions: Tocilizumab therapy was effective at decreasing mortality and should be instituted early in the management of critically ill COVID-19 patients.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

No external funding was received

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Western IRB considered this an exempt project

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Paper in collection COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv

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