Clinical course of severe patients with COVID-19 treated with tocilizumab: report from a cohort study in Spain

Expert Rev Clin Pharmacol. 2021 Feb;14(2):249-260. doi: 10.1080/17512433.2021.1875819. Epub 2021 Jan 26.


Background: We report the long-term outcomes, changes in laboratory parameters, the incidence of secondary nosocomial infections and treatment cost of a Spanish cohort of patients with severe COVID-19 that received tocilizumab (TCZ).Methods: Retrospective cohort of PCR confirmed adult patients who received TCZ from March 1 to 24, 2020 in a tertiary hospital was analyzed. Patients were followed up until 10 May 2020.Results: We included 162 patients (median age 64 years; 70.4% male). At time of TCZ administration, 48.1% of patients were on invasive mechanical ventilation (IMV). Over a median follow-up of 53 days, 46.9% of patients were discharge in good conditions and 19.8% were still hospitalized. The overall mortality was 33.3%, being higher in patients on IMV than those who did not (46.2% vs 26.7%, P < 0.001). A significant improvement in the lymphocyte count, C-reactive protein, lactate dehydrogenase, and D-dimer was observed. Overall, 43.2% patients presented nosocomial infections, causing death in 8%. Infections were more prevalent in ICU units (63.0% vs 17.1%, P < 0.001). The total cost of TCZ was €371,784.Conclusions: Among the patients who used TCZ, one third died, regardless the improvement in some inflammatory biomarkers. The incidence of secondary nosocomial infections was high.

Keywords: COVID-19; SARS-CoV-2; Spain; mortality; tocilizumab.

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • COVID-19 / epidemiology
  • COVID-19 Drug Treatment*
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • SARS-CoV-2*
  • Spain / epidemiology


  • Antibodies, Monoclonal, Humanized
  • tocilizumab

Grant support

This work was partially supported by a grant from MSD [Innovando Juntos initiative, in cooperation with the University Carlos III of Madrid, the University of Seville, the Spanish Society of Infectious Diseases and Clinical Microbiology, the Spanish Society of Hospital Pharmacy, and the Association of Science Parks and Technological of Spain].