Abstract
BACKGROUND. Tocilizumab is prescribed with corticosteroids to treat COVID-19; however, the benefits and risks of this combination are not understood, especially in older patients.
OBJECTIVES. To determine whether adding tocilizumab to corticosteroids decreases the incidence of mechanical ventilation in older patients compared to corticosteroids alone. Secondary objectives were to assess the mortality and improvements in the respiratory status.
METHODS. This retrospective cohort study was conducted at a community hospital. Patients over 65 years old diagnosed with COVID-19 between March 2020 and March 2021 were screened. Patients receiving tocilizumab in addition to corticosteroids versus patients on corticosteroids were placed into treatment and comparison groups. Chi-square statistics and odds of being placed on a ventilator within 28 days, in-hospital mortality, and the improvement in the respiratory status were calculated.
RESULTS. Of 1,651 patients screened, 355 met the inclusion criteria (176 treated patients and 179 patients in the comparison group) The incidence of being placed on a ventilator within 28 days was of 20% and 11% (OR=2.0; _p_=0.016) for the treatment and the comparison groups, respectively. Patients in the treatment group had 2.4 times the odds of dying (_p_<0.001). Patients in the treatment group had 0.9 times the odds of improvement in respiratory status (_p_=.628).
CONCLUSION AND RELEVANCE. There was no difference in the incidence of mechanical ventilation by day 28 between the patients who were on tocilizumab and those who were not. Increased mortality was seen in those who received tocilizumab and corticosteroids. The addition of tocilizumab to corticosteroids did not provide any improvement in the respiratory status and may have been harmful to older patients.