• Nicola De Rossi, Cristina Scarpazza, Chiara Filippini, Cinzia Cordioli, Sarah Rasia, Chiara Rosa Mancinelli, Damiano Rizzoni, Giuseppe Romanelli, Stefania Cossi, Nereo Vettoretto, Sergio Bove, Silvano Manfredini, Eva Andrea Beindorf, Carlo Mosca, Vittorio Scipione, Gigliola Flamminio, Elena Albini Albini, Paola Giansiracusa, Ruggero Capra, and Montichiari COVID-19 Study Group.
• Covid 19 Unit, Spedali Civili di Brescia, Presidio Ospedaliero di Montichiari, Montichiari Hospital, via Giuseppe Ciotti, Montichiari 35018, Brescia, Italy.
• EClinicalMedicine. 2020 Aug 1; 25: 100459.

BackgroundPneumonia with severe respiratory failure represents the principal cause of death in COVID-19, where hyper-inflammation plays an important role in lung damage. An effective treatment aiming at reducing the inflammation without preventing virus clearance is thus urgently needed. Tocilizumab, an anti-soluble IL-6 receptor monoclonal antibody, has been proposed for treatment of patients with COVID-19.MethodsA retrospective cohort study at the Montichiari Hospital, Brescia, Italy, was conducted. We included consecutive patients with COVID-19 related pneumonia at the early stage of respiratory failure, all treated with a standard protocol (hydroxychloroquine 400 mg daily, lopinavir 800 mg plus ritonavir 200 mg per day). We compared survival rate and clinical status in a cohort of patients who received additional treatment with tocilizumab once (either 400 mg intravenous or 324 mg subcutaneous) with a retrospective cohort of patients who did not receive tocilizumab (referred to as the standard treatment group). All outcomes were assessed at the end of the follow-up, that correspond to death or complete recovery and discharge from the hospital.Findings158 patients were included, 90 of which received tocilizumab. 34 out of 68 (50%) patients in the standard treatment group and 7 out of 90 (7.7%) in the tocilizumab group died. Tocilizumab significantly improved survival compared to standard care (multivariate HR: 0.057; 95% C.I = 0.017- 0.187, p < 0.001). No differences between the two administration routes of tocilizumab were observed. No tocilizumab-related infections and/or side effects were observed.InterpretationEarly treatment with tocilizumab could be helpful to prevent excessive hyper-inflammation and death in COVID-19 related pneumonia. Low dose administration of tocilizumab is not associated with adverse events.Fundingnone.© 2020 The Authors.

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