Does Tocilizumab Benefit Critically Ill Older Patients With COVID-19?

bald man in hospital bed receiving oxygen
Old Man and Oxygen Mask
Can older adults who are critically ill with COVID-19 safely use tocilizumab, an IL-6 inhibitor with potential immunosuppressive effects?

The monoclonal antibody tocilizumab (TCZ) lowers in-hospital mortality in severely ill older adults with COVID-19, with no associated upturn in secondary infections or other complications, according to findings of a recent multicenter, retrospective study published in the International Journal of Infectious Diseases.

TCZ has immunosuppressive properties and has been administered to critically ill patients with severe COVID-19 to combat the inflammatory markers, such as interleukin-6 (IL-6), that characterize the disease. Although TCZ has been shown to be effective against COVID-19 in younger patients, its use in older adults has been controversial because of their increased comorbidities and higher risk of death in the intensive care unit (ICU).

Investigators conducted a systematic review of medical records at 4 hospitals in 3 cities in Saudi Arabia — Riyadh, Jeddah, and Hail — and selected 368 hospitalized patients aged 65 years and older (mean age, 73.2 years) with confirmed COVID-19 infection who were admitted to ICUs between March 1, 2020, and March 31, 2021. In-hospital mortality was the primary outcome.

TCZ was given to 51 (13.8%) of the 368 patients. Those who received TCZ had lower in-hospital mortality (hazard ratio [HR], 0.41; 95% CI, 0.22-0.76; P =.005) and less chance of respiratory failure needing mechanical ventilation (MV, odds ratio [OR], 0.32; 95% CI, 0.10-0.98; P =.04). “All study patients in our cohort received their first dose of TCZ during their first day of ICU admission, which could justify the reduction of in-hospital mortality as early use might target the peak of the cytokine’s releases,” the authors noted.

The researchers found no statistically significant differences in ventilator-free days, length of stay, or complications in the ICU between groups. The TCZ group had lower 30-day mortality, but this factor did not reach statistical significance.

Limitations of the study included the retrospective nature of the research, a small sample size, and a brief follow-up period that could have prevented the detection of later infections and other complications.

“Our findings suggest that TCZ could reduce respiratory failure requiring MV and disease progression in high-risk patients such as older adult patients with COVID-19,” the authors asserted. “Further robust randomized clinical trials evaluating the safety and efficacy of TCZ among older critically ill patients with COVID-19 are needed to confirm our findings,” they advised.


Korayem GB, Aljuhani O, Altebainawi AF, et al. The safety and efficacy of tocilizumab in older adult critically ill patients with coronavirus disease 2019 (COVID-19): a multi-center, cohort study. Int J Infect Dis. Published online May 20, 2022. doi:10.1016/j.ijid.2022.05.038

This article originally appeared on Pulmonology Advisor