"Tocilizumab-an option for patients with COVID-19 associated cytokine release syndrome: A single center experience", a retrospective study-original article

Aijaz Zeeshan Khan Chachar, Khurshid Ahmed Khan, Javeid Iqbal, Adnan Hussain Shahid, Mohsin Asif, Syeda Arzinda Fatima, Asma Afzal Khan, Bilal Bin Younis, Aijaz Zeeshan Khan Chachar, Khurshid Ahmed Khan, Javeid Iqbal, Adnan Hussain Shahid, Mohsin Asif, Syeda Arzinda Fatima, Asma Afzal Khan, Bilal Bin Younis

Abstract

Background: The first case of Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed in Wuhan, China in 2019. In the first half of 2020, this disease has already converted into a global pandemic. This study aimed to find that treatment of patients with COVID-19 pneumonia with Tocilizumab or steroids was associated with better outcomes. Objectives: To analyze the effectiveness of Tocilizumab in moderate to severe Covid-19 patients based on predefined assessment criteria . Study Settings: Single-center, Fatima Memorial Hospital, Lahore.

Study design: Quasi-experimental.

Duration of study: From May 12, 2020 to June 12, 2020.

Patients & methods sample size and technique: Sample size was 93; 33 patients were kept in the experimental group, given Tocilizumab, 8 mg/kg intravenously or 162 mg subcutaneously, and the rest of the 60 patients were given corticosteroids, methylprednisolone 80 mg/day. Consecutive sampling. Failure of therapy was labeled when patients were intubated or died, and the endpoints were failure-free survival which was the primary endpoint, and overall survival secondary at the time of discharge.

Results: A total of 93 patients were enrolled, the Tocilizumab (TCZ) group (case) and Corticosteroid (CS) group (Control). The median age was 58 years (IQR-21), 37 (39.8%) patients with diabetes mellitus, 11 (11.8%) in the TCZ group, and 26 (28%) in the CS group. On the whole, the total median hospital stay in days was 7 with IQR (4), a total of 83 (89.2%) patients recovered successfully and discharged, 27 (29%) in the TCZ group and 56 (60.2%) in the CS group. Total 10 (10.8%) patients died, out of which 6 (6.5%) belonged to the TCZ group and 4 (4.3%) belonged to the CS group The median Oxygen requirement with IQR was 8 (9) in both the groups and in total as well, p-value (0.714).

Conclusions: Tocilizumab is a quite effective treatment option for critically sick patients of Covid-19 by reducing their oxygen requirement drastically and so the ICU stay, median hospital stay and so the mortality as well.

Clinicals trials registration: UIN # NCT04730323.

Keywords: Coronavirus; Covid-19; Cytokine storm syndrome; SARS-CoV-2; Tocilizumab.

Conflict of interest statement

Dr. Bilal Bin Younis was the co-author in the study and as he is also the principal of the college so his signatures included in IRB approval letter as his signature is required to issue the IRB approval certificate for everyone applying to get the project approved.

© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

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