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.