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Rev Esp Quimioter 2021; April 7

Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection

ESTELA MORENO-GARCÍA, VERÓNICA RICO, LAIA ALBIACH, DAIANA AGÜERO, JUAN AMBROSIONI, MARTA BODRO, CELIA CARDOZO, MARIANA CHUMBITA, LORENA DE LA MORA, NICOLE GARCÍA-POUTON, CAROLINA GARCIA-VIDAL, ANA GONZÁLEZ-CORDÓN, MARTA HERNÁNDEZ-MENESES, ALEXY INCIARTE, MONTSE LAGUNO, LORNA LEAL, LAURA LINARES, IRENE MACAYA, FERNANDA MEIRA, JOSEP MENSA, ANTONIO MORENO, LAURA MORATA, PEDRO PUERTA-ALCALDE, JHON ROJAS, MONTSE SOLÁ, BERTA TORRES, MANUEL TORRES, ADRIÀ TOMÉ, MONTSE TUSET, PEDRO CASTRO, SARA FERNÁNDEZ, JOSEP MARIA NICOLÁS, ALEX ALMUEDO-RIERA, JOSE MUÑOZ, MARIANA FERNANDEZ-PITTOL, MARIA ANGELES MARCOS, DOLORS SOY, JOSÉ ANTONIO MARTÍNEZ, FELIPE GARCÍA, ALEX SORIANO

Published: 7 April 2021

http://www.doi.org/10.37201/req/037.2021

Objectives. 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 around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients.
Material and 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. A total of 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 the 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.
Conclusions. Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.

Rev Esp Quimioter 2021; April 7 [Full-text PDF]