Abstract

Objective: Covid-19 widespread pandemic leading to more than 800 thousand deaths. ARDS remains leading cause of death. Cytokine release syndrome like phenomenon was observed as important contributory factor for death and IL-6 inhibitors showed promising results in multiple case series. We share our experience of Tocilizumab in patients with very severe COVID-19.Methods: In this prospective non-randomized cohort study conducted in COVID-ICU SIMS/SHL; patients who were given one or two consecutive doses of 400 mg Tocilizumab IV or subcutaneously after fulfilling criteria (Ferritin>700, CRP>70, D-Dimer>1000, FiO2 >10L, pulmonary infiltrates or worsening status) were included. Patient's data was noted on proforma. Patients were given standard treatment including IV dexamethasone, azithromycin and broad spectrum antibiotic, Invasive or non-invasive ventilation and proning from day one.Results: Twenty one (M=19, F=2) patients having severe or very severe Covid requiring invasive ventilation 17(81%) and non-invasive ventilation 4 (19%)were given Tocilizumab (400mg two doses) along with dexamethasone, antibiotics and general care. Average age was 58.9 + 7. Majority of the patients were below 65 years. Out of 21 patients 4 patients improved and 3 discharged 1still admitted, mortality 81%(n=17). Raised inflammatory marker like CRP, Ferritin, D-Dimer and LDH and these improved after tocilizumab while Oxygen requirement doesn't improved significantly in majority of patients (n=20,95%)apart from 4 patients who improved gradually over next 7-10th day.Conclusion: In very severe, steroids refractory COVID-Related ARDS Tocilizumab doesn't showed statistically significant improvement in outcome.