Background : Controversy remains about the efficacy of tocilizumab (TCZ) for the treatment of severe COVID-19. We aimed to analyze the profile of TCZ-respondent patients. Methods : We retrospectively analyzed a cohort of patients with severe COVID-19 admitted to the University Hospital “12 de Octubre” until May, 2020 that received off-label TCZ after indication of a local Committee. The primary end point was significant clinical improvement at day 14 after TCZ (SCI). Factors independently related with SCI were analyzed by multivariate logistic regression models. Results : Out of 428 patients treated with TCZ, 271(63.3%) experienced SCI. After adjustment by factors related with unfavorable outcome, TCZ administration within the first 48 hours from admission (odds ratio [OR]: 1.98, 95% confidence Interval [95% CI]: 1.1 – 3.55; P-value = 0.02) and ALT levels >100 UI/L at day 0 (OR: 3.28; 95% CI:1.3 –8.1; P-value = 0.01) were independently related with SCI. The rate of SCI significantly decreased according timing of TCZ: 70.2% first 48 hours from admission, 58.5% day 3 to 7 and 45.1% beyond day 7 (P-values = 0.03 and 0.001 respectively). Conclusion : TCZ improves the prognosis of patients with COVID-19 mostly if treatment is started within the first 48 hours of admission.
Analysis of the factors predicting clinical response to tocilizumab therapy in patients with severe COVID-19