A retrospective, observational study published in Lancet Rheumatology has shown that tocilizumab (TCZ) may reduce the risk of death or the need for mechanical ventilation in severe COVID-19 pneumonia.

This observational study included adults, with severe COVID-19 pneumonia, who were hospitalized between Feb 21 and March 24, 2020. All were on the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received TCZ. Tocilizumab was given either intravenously at 8 mg/kg bodyweight (up to a maximum of 800 mg) in two infusions, 12 h apart, or subcutaneously at 162 mg administered in two simultaneous doses, if the IV formulation was unavailable.

Among a total of 1351 Italian patients admitted, 544 (40%) with severe COVID-19 pneumonia and were included in the study.  179 received TCZ and 365 received standart of care. The primary endpoints were:

• Mechanical ventilation: 16% of the control group vs. 18% of TCZ treated patients (p=0·41)
• Death: 20% of control patients vs. 7% in the TCZ patients (p<0·0001)

After adjustment for sex, age, centre, duration of symptoms, and SOFA score, tocilizumab treatment was associated with a reduced risk of invasive mechanical ventilation or death (adjusted hazard ratio 0·61, 95% CI 0·40–0·92; p=0·020).

New infections were more likely with TCZ (13%) versus control (standard of care) patients (4%) (p<0·0001).

TCZ, given intravenously or subcutaneously, may reduce the risk of invasive mechanical ventilation or death in severe COVID-19 pneumonia.

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