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151: Does Tocilizumab Improve Survival Outcome in COVID-19 Acute Respiratory Distress Syndrome Patients?

INTRODUCTION: SARs-CoV-2 (COVID-19), was declared a global pandemic by the World Health Organization on March 11, 2020 Hence, there is an urgency to find effective treatment Data are needed regarding the benefit of treatment and prevention of the cytokine storms in COVID-19 patients with Tocilizumab METHODS: Clinical outcomes data for patients admitted to Orange Regional Medical Center with confirmed COVID-19 from Mar 15, 2020 to Apr 20, 2020 were identified through electronic health record chart review We conducted a retrospective case-control study in confirmed COVID 19 positive patients with ARDS requiring mechanical ventilation and compared outcome in terms of mortality and length of stay amongst those who received Tocilizumab as treatment modality opposed to those that did not RESULTS: A total of 94 patients with COVID-19 ARDS were analyzed 44 were in the study group and 50 in the control group We tried to match both group as close as possible in terms of age, sex, BMI and HS score- calculated using inflammatory markers- ferritin, triglycerides, AST and fibrinogen The median age was 55 5 years in the study group and 66 in the control group, difference was not statistically significant Average HS score was 114 in the Tocilizumab group and 92 in the control group, difference was statistically significant with P<0 0001 Also, the patients in the study group had elevated levels of IL-6, triglycerides, AST, ferritin which were statistically significant with p < 0 0001 when compared to the control group Length of stay was longer, average 17 9 days in the Tocilizumab Survival rate was much lower at 48 % in the control group and 61 36 % in patients who received Tocilizumab but p value was insignificant 0 2185 The number needed to treat (NNT) was 7 48, if we treat 8 patients with Tocilizumab, 1 will survive CONCLUSIONS: Cytokine Release Syndrome (CRS) occurs in a large number of patients with severe COVID-19, which is also an important cause of death IL- 6 is the key molecule of CRS, so IL-6R antagonist Tocilizumab may be of value in improving outcomes Results have to be interpreted with caution since this is a retrospective study and mortality is affected by multiple, confounding factors We await the results of ongoing ran