Publication:

Outcome of severe to critical COVID-19 patients with tocilizumab therapy

Background The inflammatory response plays a critical role in COVID 19 and inflammatory cytokine storm increases the severity of COVID-19. Tocilizumab, an IL-6 receptor monoclonal antibody, has been used for the treatment of patients with COVID-19. This study compared the outcome of tocilizumab therapy with other standard therapy in the management of severe to critical COVID-19 patients.

Methods This observational prospective comparative study was conducted at the COVID-19 unit of Bangabandhu Sheikh Mujib medical university (BSMMU), for one year period following approval of this protocol. A total of 60 severe to critical COVID-19 patients were enrolled in this study and categorized into two groups: Tocilizumab along with standard therapy (n=30) and another group receiving standard therapy only (n=30). After taking written informed consent, a detailed history and thorough clinical examination were carried out along with relevant investigations. After the collection of all the required data, analysis was done by SPSS 24.0.

Results The study's predominantly male patients (mean age 53.7±11 years) had high rates of hypertension (63.3%) and diabetes (48.3%), with most experiencing severe COVID-19 (76.6%). Initial similarities in both groups included socio-demographics and disease severity (p>0.05). After 2 weeks, the tocilizumab group had lower WBC counts (5.15±2.39 vs 7.56±1.47×109/l), lower CRP levels (2.7±0.93 vs 7.5±2.38 mg/l, p<0.05), shorter hospital stays (18.25±4.58 vs 25.4±2.70 days, p=0.005), reduced oxygen requirements (7.25±4.23 vs 12±7.29%, p=0.005), and lower mortality (40% vs 66.66%, p=0.027).

Conclusions Tocilizumab therapy has better outcomes in severe to critical COVID-19 patients. However, a further larger study is recommended.