Retrospective Observational Analysis of Tocilizumab Outcomes in COVID-19 Patients at a Tertiary Care Hospital

Vrushali Aringale; Bharti Daswani; Madeline Fernandes

doi:10.18502/jpc.v12i1.16027

Vrushali Aringale Department of Pharmacology, BJ Govt Medical College, Pune, India.
Bharti Daswani Department of Pharmacology, BJ Govt Medical College, Pune, India.
Madeline Fernandes Department of Pharmacology, BJ Govt Medical College, Pune, India.

DOI: https://doi.org/10.18502/jpc.v12i1.16027

Keywords: Cytokine Storm; Immunosuppressive Drug; Interleukin-6 Inhibitor

Abstract

Background: Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), was recommended for treatment of Covid-19 patients with a risk of cytokine storm but showed variable effect on outcome. The aim was to assess the association of outcome following tocilizumab administration with various physiological, pathological and pharmacological factor in Covid- 19 patients

Methods: Retrospective observational study from June 2020 to July 2020. All indoor Covid positive patients who received tocilizumab were included and relevant information was captured in the case record form. Data was analyzed to the study association of various physiological factors, comorbidities, severity of disease, laboratory parameters and co-administered drugs with the outcome following tocilizumab administration.

Results: Total 25 patients received tocilizumab during study period. Older age group (p=0.001), high NEWS score, hypertension (OR: 3.62; p=0.05) and hydroxychloroquine(HCQ) administration (OP=6.66; p=0.009) showed significant association with a worst outcome. Hypertension and hydroxychloroquine usage was analyzed after adjustment with NEWS score using MH adjusted analysis, which revealed a trend of worst outcome in HCQ recipients but the association was not significant with hypertension. High pre-treatment IL-6 (death 570.11+498.76; discharge110.31+ 49.68; p: 0.0011); high post-treatment ferritin level (death 1756.5+ 1622.03; discharge 711.71+ 421.23; p: 0.019) as well as post-tocilizumab rise in ferritin level was associated with worst outcome (p= 0.029).

Conclusion: Participants having higher cytokine level/or high NEWS score were unlikely to benefit from tocilizumab. Increased in ferritin level even after tocilizumab appeared to be an indicator of failure of treatment.