Experience of tocilizumab using in patients with COVID-19 in the Ivano-Frankivsk region

Abstract

Introduction. To eliminate the effects of the «cytokine storm» in patients with COVID-19 glucocorticosteroids are prescribed, and in severe cases — tocilizumab. Aim. To study the effectiveness of tocilizumab in patients with the severe course of the coronavirus disease COVID-19 and respiratory failure in the intensive care unit. Material and methods. Retrospective analysis of 20 cases of COVID-19 with a critical course in the intensive care unit. The average age of patients was 59.8±1.9 years. Group I included 10 individuals who received tocilizumab with a course dose of 800 mg; II group included 10 individuals who did not receive tocilizumab. Patients out both groups are not given any antiviral drugs or human normal immunoglobulin for intravenous introduction. Coagulogram, CRP, D-dimers, IL-6, procalcitonin were determined. Statistical processing of the results was carried out by a non-parametric methods using the Mann-Whitney U-test and G-criteria of signs. Results and discussion. In patients out the group I, leukocytosis was observed in the range of 8.9-15.5×109/l, lymphopenia in the range of 0.69-2.1×109/l, eosinopenia — 0-1%, neutrophil-lymphocyte index — 3.1-14,9; ESR — 24-53 mm/h, CRP — 58-125 mg/l, IL-6 — 109-2196 pg/ml, procalcitonin — 0.6-4.7 ng/ml. In patients out the II group, these indicators had a similar value. As a result of tocilizumab using no significant clinical improvement in the general condition of patients was observed. In group I 7 individuals died (70.0%), and mortality in group II was 5 (50%), p>0.05. Hyperleukocytosis (26.4-39.4×109/l) was revealed in part of the patients treated with tocilizumab — 6 (60.0%). It appeared in 1-2 days after the administration of the drug and had been persisted for 13-20 days up to disappearing, if patients survived. Conclusions. The appointment of tocilizumab in a course dose of 800 mg did not have a statistically significant effect of increasing the survival of patients with COVID-19 with a critically severe course may be due to the lack primary appointment of antiviral agents and rational correction of antibiotic therapy.