Tocilizumab as a targeted immunomodulatory therapy in the management of severe respiratory illnesses: a multicenter cohort study of COVID-19 patients

Respiratory pandemics like COVID-19 continued to strain healthcare systems worldwide. Numerous antiviral, antimalarial, and anti-inflammatory treatments were administered to many patients to pursue effective therapeutics. This study aims to assess the efficacy of the anti-inflammatory agent tocilizumab for critically ill patients, specifically in managing respiratory illnesses. This multi-center cohort study included laboratory-confirmed SARS-CoV-2 patients as special cases admitted to the intensive care units (ICUs) of 15 hospitals across Saudi Arabia between March 1, 2020, and October 30, 2020. A total of 1470 critically ill patients with SARS-CoV-2 were included. The study included 1470 patients with a mean age of 55.9 +/- 15.1 years; 1088 (74.0%) were male and 382 (26.0%) female. Among them, 29% received Tocilizumab, while 71% received other treatments such as remdesivir, hydroxychloroquine, corticosteroids, convalescent plasma, intravenous immunoglobulin, and plasmapheresis. The median Sequential Organ Failure Assessment (SOFA) score for the cohort was 5 [IQR 3-8], with lower scores observed in the Tocilizumab administered group (p = 0.143). ICU mortality was significantly lower in the tocilizumab group: 150/426 (35.2%) versus 457/1044 (43.8%), p = 0.004. The median length of ICU stay was longer in the Tocilizumab group (12 days; IQR 7-21) than in the non-Tocilizumab group (8 days; IQR 4-15). However, Tocilizumab use was associated with a reduced likelihood of prolonged ICU stay (adjusted OR 0.68; 95% CI 0.57-0.83; p < 0.001). Similarly, the median hospital stay was longer among Tocilizumab recipients (18 days; IQR 12-30) compared to non-recipients (14 days; IQR 8-23). Despite the longer duration, Tocilizumab was associated with a decreased likelihood of extended hospital stay (adjusted OR 0.72; 95% CI 0.57-0.91; p = 0.003). These findings support the beneficial role of Tocilizumab in managing acute respiratory illness due to COVID-19. This study suggests that tocilizumab, particularly when administered early, is associated with reduced mortality and improved outcomes in critically ill patients. These findings not only support the use of tocilizumab as a therapeutic option for severe cases of COVID-19 but also highlight its potential for future respiratory pandemics. Early intervention with tocilizumab may lead to significant benefits, offering a valuable treatment strategy with manageable adverse effects for critically ill patients in future global health crises.