Tocilizumab is associated with reduced risk of ICU admission and mortality in patients with SARS-CoV-2 infection

  1. Estela Moreno-GarcĂ­a
  2. VerĂłnica Rico
  3. Laia Albiach
  4. Daiana AgĂĽero
  5. Juan Ambrosioni
  6. Marta Bodro
  7. Celia Cardozo
  8. Mariana Chumbita
  9. Lorena De la Mora
  10. Nicole GarcĂ­a-Pouton
  11. Carolina Garcia-Vidal
  12. Ana González-Cordón
  13. Marta Hernández-Meneses
  14. Alexy Inciarte
  15. Montse Laguno
  16. Lorna Leal
  17. Laura Linares
  18. Irene Macaya
  19. Fernanda Meira
  20. Josep Mensa
  21. Antonio Moreno
  22. Laura Morata
  23. Pedro Puerta-Alcalde
  24. Jhon Rojas
  25. Montse Solá
  26. Berta Torres
  27. Manuel Torres
  28. Adrià Tomé
  29. Pedro Castro
  30. Sara Fernández
  31. Josep Maria Nicolás
  32. Alex Almuedo-Riera
  33. Jose Muñoz
  34. Mariana Jose Fernandez-Pittol
  35. Maria Angeles Marcos
  36. Dolors Soy
  37. José Antonio Martínez
  38. Felipe GarcĂ­a
  39. Alex Soriano
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Abstract

Background

In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management worldwide; therefore, clinical strategies to avoid ICU admission are needed.

Objective

We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients.

Methods

A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first.

Results

77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P = 0.005) and need of invasive ventilation (0 vs 13.8%, P =0.001). In multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0·1, P =0.0001) of ICU admission or death.

Conclusion

Tocilizumab in the early stages of the inflammatory flare, could reduce ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports.

Clinical implication

Our results suggest that tocilizumab administered to non-critically ill patients could reduce ICU admissions and mortality.

Capsule summary

Tocilizumab administered to non-critically ill patients with SARS-CoV-2 infection in the early stages of the inflammatory flare, could reduce an important number of ICU admissions and mechanical ventilation use.

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