In this multicentre retrospective observational cohort study recently published in Lancet Rheumatology, the authors investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19. They compared outcomes in patients who received tocilizumab with those who did not, applying a multivariable Cox model with propensity score matching to reduce confounding effects. The primary endpoint was hospital-related mortality. 630 patients were included in the propensity score-matched population, of whom 210 received tocilizumab and 420 did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. Overall median survival from time of admission was not reached (95% CI 23 days–not reached) among patients receiving tocilizumab and was 19 days (16–26) for those who did not receive tocilizumab (hazard ratio [HR] 0·71, 95% CI 0·56–0·89; p=0·0027). In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (HR 0·64, 95% CI 0·47–0·87; p=0·0040). Similar associations with tocilizumab were noted among subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg/dL or higher. The authors concluded that in this observational study, patients with COVID-19 requiring ICU support who received tocilizumab had reduced mortality. However, they underline that results of ongoing randomised controlled trials are awaited.
