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252: Tocilizumab, Corticosteroids, and Anticoagulation in COVID-19 Patients on Mechanical Ventilation

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) can lead to rapid respiratory decompensation requiring mechanical ventilation There is limited evidence regarding the efficacy of existing treatment for severe COVID-19 infection The purpose of this study was to assess the efficacy and safety of tocilizumab (TCZ) alone or with the combination of corticosteroids and therapeutic anticoagulation in intensive care unit (ICU) patients on mechanical ventilation with COVID-19 infection METHODS: A single-center observational cohort study was conducted at an urban community teaching hospital in the New York City area between March 9, 2020 and April 28, 2020 The primary outcome of this study was in-hospital mortality Secondary outcomes included 30-day mortality, duration of mechanical ventilation, ICU length of stay, and hospital length of stay RESULTS: A total of 152 COVID-19 positive ICU patients were included in this study, of which 40 (26 7%) patients received one dose of TCZ 400 mg IV and three patients received an additional 400 mg dose There were no statistically significant differences noted between the treatment and control group in regards to in-hospital mortality [31 (77 5%) vs 94 (83 9%), P = 0 35], 30-day mortality [28 (70%) vs 90 (80 4%), P = 0 18], or duration of mechanical ventilation (13 days ± 15 4 vs 9 7 days ± 10 6, P = 0 22) Patients receiving TCZ had a significantly longer ICU and hospital length of stay [(15 1 days ± 16 1 vs 9 6 days ± 9 8, P = 0 05) and (25 5 ± 29 9 vs 14 1 ± 16 9, P = 0 03), respectively] There was no difference in the incidence of thromboembolic complications [7 (17 5%) vs 9 (8%), P = 0 13] or atrial fibrillation [4 (10%) vs 13 (11 6%), P = 1 0] between the two groups No anaphylactic or injective site reactions were noted Results of multivariate linear and logistic regression analyses demonstrated that corticosteroids and anticoagulants were not independent predictors of duration of mechanical ventilation or in hospital mortality CONCLUSIONS: The use of TCZ alone or in combination with corticosteroids and therapeutic anticoagulation was not associated with a decreased risk of mortality or shorter duration of mechanical ventilation in critically ill patients with COVID-19 infection Additional studies are needed to evaluate the efficacy of TCZ for COVID-19