Effectiveness of Tocilizumab in reducing inflammatory response associated with COVID-19 pneumonia at Islamabad Medical Complex, Islamabad

Abstract

Objective: To determine the effectiveness of Tocilizumab in covid-19 related severe pneumonia. Introduction: COVID-19 is a global health problem causing respiratory infection. This is triggered by IL-6 characterized by raised inflammatory markers that is called cytokine release storm. Severe disease leads to hospitalization, oxygen requirement and poor outcome. Methods: This interventional study (descriptive analytic) was conducted from July-December 2021 at Intensive Care Unit, after ethical approval. Seventy cases of COVID-19 pneumonia with cytokine storm were included. Twenty cases were dropped either refusal to tocilizumab, pregnancy or having contraindication to tocilizumab, leaving 50 study participants. The patient’s demography, clinical, laboratory and radiological findings, timing and response variables of tocilizumab were recorded. The temporal readings of inflammatory markers, oxygen requirement and clinical status were compared at admission and after tocilizumab. SPSS version 25 was used for data analysis. Chi-square test was applied with significant p-value < 0.05. Results: There was male predominance of 66% with mean age of 58.6±14.8 years. Mean day of illness and hospital stay was 8th day and 17.56 days respectively. C-reactive protein levels improved in all cases 50(100%) (p <0.0001), ferritin in 31(62%) (0.019), D dimers in 28 (56%) (p0.014), LDH in 30(60%) (p 0.02) and interleukin-6 in 32(64%) (0.017. Survival benefit with tocilizumab was significant in patients that received within 10th day of illness (p 0.021). At discharge, 66.6% were off oxygen and 33.3% required domiciliary oxygen. Conclusion: COVID-19 Pneumonia with cytokine release storm bears high mortality. Significant improvement in inflammatory markers like CRP, ferritin, D-dimers and LDH shows effectiveness of tocilizumab. Early administration within 10 days of illness has survival benefits.