Clinical course of severe patients with COVID-19 treated with tocilizumab: report from a cohort study in Spain

ABSTRACT

Background: We report the long-term outcomes, changes in laboratory parameters, the incidence of secondary nosocomial infections and treatment cost of a Spanish cohort of patients with severe COVID-19 that received tocilizumab (TCZ).

Methods: Retrospective cohort of PCR confirmed adult patients who received TCZ from March 1 to 24, 2020 in a tertiary hospital was analyzed. Patients were followed up until 10 May 2020.

Results: We included 162 patients (median age 64 years; 70.4% male). At time of TCZ administration, 48.1% of patients were on invasive mechanical ventilation (IMV). Over a median follow-up of 53 days, 46.9% of patients were discharge in good conditions and 19.8% were still hospitalized. The overall mortality was 33.3%, being higher in patients on IMV than those who did not (46.2% vs 26.7%, P < 0.001). A significant improvement in the lymphocyte count, C-reactive protein, lactate dehydrogenase, and D-dimer was observed. Overall, 43.2% patients presented nosocomial infections, causing death in 8%. Infections were more prevalent in ICU units (63.0% vs 17.1%, P < 0.001). The total cost of TCZ was €371,784.

Conclusions: Among the patients who used TCZ, one third died, regardless the improvement in some inflammatory biomarkers. The incidence of secondary nosocomial infections was high.

KEYWORDS:

• COVID-19
• mortality
• SARS-CoV-2
• Spain
• tocilizumab

Article highlights

• In the beginning of the pandemic tocilizumab use was not guided by IL6 serum levels

• The overall mortality was 33% (46% with mechanical ventilation vs 27% without)

• An improvement in inflammatory parameters was observed, except for ferritin

• The incidence of nosocomial infections was 43%, causing death in 8% of patients

• The cost of tocilizumab was high (median cost per patient €2,096).

Acknowledgments

The authors thank Athento® for their assistance in data mining. The authors thank J.M. Bellón for his assistance with the statistical analyses. The authors thank Angelica Minero Escobar for editing the article.

Author contributions

E. Chamorro-de-Vega and C. Rodriguez-Gonzalez drafted the manuscript, critically revised the manuscript for important intellectual content. S. Manrique-Rodríguez substantially contributed to conception or design, contributed to acquisition, analysis, or interpretation of data. E. Lobato-Matilla, F. Garcia-Moreno, P. Ruiz-Briones, R. Romero-Jiménez, A. Gimenez-Manzorro, R. Collado-Borrell, J.L. Revuelta-Herrero, B. Somoza-Fernandez, S. Garcia-Sanchez, C. Sarobe-González, C.M. Fernandez-Llamazares and I. Taladriz-Sender contributed to acquisition, analysis, or interpretation of data. M. Olmedo, R. Correa-Rocha, T. Aldámiz-Echevarria, M. Valerio, M. Machado, M. Sancho-Gonzalez and M. Sancho-Gonzalez critically revised the manuscript for important intellectual content. E. Bouza, A. Herranz, P. Muñoz and M. Sanjurjo substantially contributed to conception or design.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was partially supported by a grant from MSD [Innovando Juntos initiative, in cooperation with the University Carlos III of Madrid, the University of Seville, the Spanish Society of Infectious Diseases and Clinical Microbiology, the Spanish Society of Hospital Pharmacy, and the Association of Science Parks and Technological of Spain].