Safety and Efficacy of Tocilizumab in critically ill patients with COVID-19: An Observational study
Authors: Youssef Ghada Ali , Wagih Helmy Khaled Mohamed , Mohamed Abdel-hamid Hossam Eldin 
Published: July 2024

Abstract

Background
The current coronavirus disease 2019 (COVID-19) outbreak is a worldwide emergency, as its rapid spread and high mortality rate has caused severe disruptions. The number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2), the causative agent of COVID-19, is rapidly increasing worldwide. Patients with COVID- 19 can develop pneumonia. Severe symptoms of acute respiratory distress syndrome (ARDS), and multiple organ failure.

Aim of the Work
to compare Compare between clinical symptoms (MMRC Dyspnea score), oxygen therapy, TlC & Lymphocytic count and inflammatory markers (CRP, serum ferritin, D.dimer) before and after the administration of 2 doses of tocilizumab noting that the second dose is given within 24-48 hours from first dose on 50 patients admitted to Ain-Shams isolation university hospital at Al-Obour, Ain-shams Geriatrics isolation hospital and Ain- shams isolation field hospital from 1st of May 2020 to 1st of January 2022.

Patients and Methods
Baseline cbc with differential, liver function tests, kidney functions tests, D dimer, serum ferritin and CRP. 2 doses of tocilizumab given on two days, first dose is 8mg/kg diltuted in 100 cc saline 0.9% given along 1 hour while the second dose (4mg/kg diltuted in 100 cc saline 0.9%) is given after 24 hours. Follow up inflammatory markers (cbc with differential, crp, d dimer, serum ferritin) were withdrawn after 3 days from second dose of tocilizumab. Assestment of clinical symptoms after 48 hours of second dose of tocilizumab. Assestment of oxygen thearpy on day 2 and day 30 after administration of tocilizumab.

Results
the administration of tocilizumab highly significantly improves some clinical symptoms (bony aches, fatigue, fever) while worsens expectoration, but highly significantly improves oxygen therapy and po2/fio2 ratio, with no significant effect on inflammatory marker other than CRP which showed marked increase. Tocilizumab shows neither effect on patients’ fate and mortality nor on hospital stay although mean age of 63 was statistically highly significant on increased patients’ mortality and renal impairment significantly affected length of hospital stay. the effect of timing of tocilizumab administration on patients’ fate and mortality showed non statistically significant improvement when given from day 6 to day 10 since onset of symptoms

Conclusion
The administration of tocilizumab highly significantly improves clinical symptoms, oxygen therapy and po2/fio2 ratio, with no siginifcant effect on inflammatory marker other than CRP which showed marked increase, which may be attributed to early withdrawal of inflammatory markers. Tocilizumab shows neither effect on patients’ fate and mortality nor on hospital stay although mean age of 63 was statistically highly significant on increased patients’ mortality and renal impairment significantly affected length of hospital stay. We studied the effect of timing of tocilizumab administration on patients’ fate and mortality which showed non statistically significant improvement when given from day 6 to day 10 since onset of symptoms which may be due to small sample size.