Outcome of COVID-19 pneumonia treatment with Tocilizumab at Phra Nakhon Si Ayutthaya Hospital

Abstract

COVID-19 is a pandemic disease with various clinical manifestations: asymptomatic, mild, moderate and critical symptom by cytokine release syndrome (CRS). Many studies showed the benefits of Tocilizumab administration in the patients with CRS. In the shortage situation, this drug is very expensive, so we aim to study the appropriation of tocilizumab administration. The result of this study may lead to guide how to use this drug in Phra Nakhon Si Ayutthaya hospital.

          There were 124 critical COVID-19 pneumonia patients in Phra Nakhon Si Ayutthaya hospital between June 1^st and October 31^st 2021. These patients were treated with high flow nasal cannula oxygen therapy with flow 60 litre per minute with mean FiO₂ 0.8. Thirty-eight patients were dead, with mortality rate 30.6 %. There were 15 patients treated with Tocilizumab  and factors affecting death in COVID-19 patients treated with Tocilizumab were elderly with age more than 60 years and diabetes mellitus with odds ratio 40 and 2.5 respectively.

Tocilizumab administration in critical COVID-19 patients in this hospital cannot reduce mortality because the severity in tocilizumab group was more severe than in standard of care group. Moreover, there were only few patients with tocilizumab treatment, so there was no power to show the benefit in this study. We should have further study about the appropriate time of Tocilizumab administration in CRS.