Tocilizumab improves survival in patients with persistent hypoxia in severe COVID-19 pneumonia
Yojana Gokhale, Rakshita Mehta, Nitin Karnik, Uday Kulkarni, Sushant Gokhale
eClinicalMedicine, doi:10.1016/j.eclinm.2020.100467
Kewan et al. [1] have shown that using single dose 400 mg tocilizumab reduces the duration of critical resource use in severe Coronavirus disease 2019 (COVID-19) pneumonia. They had included patients with hypoxia, lung infiltrates and elevated inflammatory markers. We work at a government-funded tertiary care center in India. We had compassionate use access to tocilizumab from 13th May 2020. In view of resource-limitation, we decided to use it in patients with severe COVID-19 pneumonia with lung infiltrates, elevated inflammatory markers and persistent hypoxia (oxygen saturation of 94% or less despite giving supplemental oxygen of 15 L/min via non-rebreathing mask or PaO 2 / FiO 2 ratio of less than 200). We present data from a retrospective cohort study performed at our center over a 6 week period from 20th April 2020 to 5th June 2020. A total of 1370 patients with COVID-19 were admitted in the department of medicine during this period. Of these, 985 (72%) had hypoxia, defined as oxygen saturation 94% or less, at presentation. Of these, 210 patients met the inclusion criteria of oxygen saturation of 94% or less despite giving supplemental oxygen of 15 L/min via nonrebreathing mask or PaO 2 /FiO 2 ratio of less than 200. Of these, 49 patients died within 24 h of admission and were excluded from the analysis. The remaining 161 patients were considered for analysis. Of the 161 patients, 70 received a single intravenous dose of 400 mg tocilizumab while 91 did not. All patients received antibiotics, hydroxychloroquine 400 mg once daily, ivermectin 12 mg once daily, oseltamivir 75 mg twice daily, low molecular weight heparin 1 mg/ kg subcutaneously once daily (twice daily if D-dimer >3000 ng/mL), methylprednisolone 125À500 mg intravenously once daily, and other supportive care as needed. Tocilizumab group had younger patients than control group (median 52 years versus 55 years; p value 0¢001) (Table 1 ). Eight
Kewan, Covut, Mj, Rose, Gopalakrishna et al., Tocilizumab for treatment of patients with severe COVID-19: a retrospective cohort study, EClin Med
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