Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia

Eur J Intern Med. 2020 Jun;76:31-35. doi: 10.1016/j.ejim.2020.05.009. Epub 2020 May 13.


Background: Pneumonia with respiratory failure represents the main cause of death in COVID-19, where hyper inflammation plays an important role in lung damage. This study aims to evaluate if tocilizumab, an anti-soluble IL-6 receptor monoclonal antibody, reduces patients' mortality.

Methods: 85 consecutive patients admitted to the Montichiari Hospital (Italy) with COVID-19 related pneumonia and respiratory failure, not needing mechanical ventilation, were included if satisfying at least one among: respiratory rate ≥ 30 breaths/min, peripheral capillary oxygen saturation ≤ 93% or PaO2/FiO2<=300 mmHg. Patients admitted before March 13th (n=23) were prescribed the standard therapy (hydroxychloroquine, lopinavir and ritonavir) and were considered controls. On March 13th tocilizumab was available and patients admitted thereafter (n=62) received tocilizumab once within 4 days from admission, plus the standard care.

Results: Patients receiving tocilizumab showed significantly greater survival rate as compared to control patients (hazard ratio for death, 0.035; 95% confidence interval [CI], 0.004 to 0.347; p = 0.004), adjusting for baseline clinical characteristics. Two out of 62 patients of the tocilizumab group and 11 out of 23 in the control group died. 92% and 42.1% of the discharged patients in the tocilizumab and control group respectively, recovered. The respiratory function resulted improved in 64.8% of the observations in tocilizumab patients who were still hospitalized, whereas 100% of controls worsened and needed mechanical ventilation. No infections were reported.

Conclusions: Tocilizumab results to have a positive impact if used early during Covid-19 pneumonia with severe respiratory syndrome in terms of increased survival and favorable clinical course.

Keywords: COVID-19; Pneumonia; Respiratory failure; Retrospective study; SARS-cov-2; Tocilizumab.

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized* / administration & dosage
  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Antiviral Agents / adverse effects
  • Betacoronavirus / drug effects
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / therapy
  • Dose-Response Relationship, Drug
  • Early Medical Intervention / methods
  • Female
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / etiology
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / therapy
  • Receptors, Interleukin-6 / antagonists & inhibitors*
  • Respiration, Artificial / methods*
  • Respiratory Function Tests / methods
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / mortality
  • Respiratory Insufficiency* / therapy
  • Retrospective Studies
  • SARS-CoV-2


  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Receptors, Interleukin-6
  • tocilizumab