Tocilizumab May Benefit Mechnically-Ventilated Patients With COVID-19

Patient lies in hospital bed attached to medical oxygen
Black male patient hospitalized with mechanical ventilator.
Researchers assessed the effects of tocilizumab among mechanically-ventilated patients hospitalized with COVID-19.

Treatment with tocilizumab was found to significantly decrease the duration of mechanical ventilation and the risk of mortality in patients hospitalized with COVID-19 infection, according to study findings published in Heart & Lung.

Researchers conducted a retrospective, observational, competing risk analysis among mechanically-ventilated patients admitted to an intensive care unit (ICU) with COVID-19 infection at a hospital in Saudi Arabia between March and June 2020. The researchers used 1:1 nearest-neighbor and propensity-score matching to assign patients to an intervention group or control group. Patients in the intervention group received tocilizumab and were matched against controls on the basis of age, sex, COVID-19 severity, comorbidities, smoking status, BMI, and receipt of steroids or antivirals. The primary composite outcome was the number of ventilator-free days, reported as the sub-distribution hazard ratio (SHR) based on the Fine and Gray method.

Among patients included in the final analysis, 29 received tocilizumab and 29 were assigned to the control group. Demographic characteristics did not significantly differ between the 2 patient groups.

The researchers found that patients who received tocilizumab demonstrated a 170% greater chance of survival and extubation within 28 days compared with those in the control group (SHR, 2.7; 95% CI, 1.2-6.3; P =.02).

Further analysis showed that the rate of 28-day mortality was decreased among patients in the tocilizumab group vs those in the control group (37.9% vs 62.0%; 95% CI of difference, -3.9 to 48.5; P =.1). Of note, all patients who died were in the ICU and mechanically ventilated at the time of death.

In a subgroup analysis among patients receiving steroids, the number of ventilator-free days was significantly increased among patients who received tocilizumab vs those in the control group (10 vs 0 days; mean difference, 4.7; 95% CI, 1.1-8.3; P =.02).

A Cox proportional hazards regression analysis showed that treatment with tocilizumab was associated with a 51% decreased risk of 28-day mortality.

Study limitations include the lack of power, the small sample size, the retrospective design, the lack of randomization, and the method of group allocation.

“It has been postulated that [tocilizumab] treatment may be able to attenuate the…cytokine storm associated with SARS-CoV-2 infection and prevent the progress of the infection into [acute respiratory distress syndrome],” the researched noted. “These findings need to be confirmed in larger prospective randomized trials,” they concluded.


Mady AF, Abdulrahman B, Mumtaz SA, et al. “Ventilator-free days” composite outcome in patients with SARS-CoV-2 infection treated with tocilizumab: a retrospective competing risk analysis. Heart Lung. 2022;56:118-124. doi:10.1016/j.hrtlng.2022.06.024