Evaluating the Effects of Nebulized Tocilizumab versus Intravenous Tocilizumab in the Management of Severe Coronavirus Disease 2019 Cases: A Randomized Clinical Trial

Background: Tocilizumab has shown promising effects in the management of coronavirus disease 2019 (COVID-19) patients. Nebulized tocilizumab might reduce this inflammation while also reducing the potential side effects of systemic administration, including infectious complications. This study aimed to compare the efficacy of tocilizumab in the management of COVID-19 in two administration routes (intravenous versus nebulization). Methods: The study was a randomized, outcome assessor-blinded clinical trial performed on 101 patients. For the 1(st) 72 h after their admission, all patients received dexamethasone and remdesivir. Any patients who did not respond to treatment after 2 days received 400 mg intravenous tocilizumab on day 3. Patients who were eligible for receiving the second dose of tocilizumab were randomized into two groups. Group one received the second dose of tocilizumab 400 mg 12 h later through the intravenous route, while the patients in group two received a total of 400-mg tocilizumab through nebulization of 5 cc every 6 h after the first intravenous dose. The primary outcomes were the need for ventilation and admission in the intensive care unit, as well as the mortality rate. Reults: There was no significant difference between the two groups in terms of mortality rate, the need for mechanical ventilation, the length of hospital stay, lung radiologic changes, or laboratory values. The need for noninvasive mechanical ventilation was lower in the nebulized tocilizumab group than in the intravenous tocilizumab group (P = 0.05). Conclusion: Administration of tocilizumab through nebulization may have the same beneficial effects with less potential side effects than intravenous tocilizumab.