J Med Virol. Tocilizumab for the Treatment of Severe COVID-19

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J Med Virol. 2020 May 5. doi: 10.1002/jmv.25964. [Epub ahead of print]
Tocilizumab for the Treatment of Severe COVID-19.


Alattar R¹, Ibrahim TBH¹, Shaar SH¹, Abdalla S¹, Shukri K¹, Daghfal JN¹, Khatib MY², Aboukamar M¹, Abukhattab M^1,3, Alsoub HA^1,3, Almaslamani MA^1,3, Omrani AS^1,3.

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Abstract

INTRODUCTION:

Tocilizumab, an nterleukin-6 inhibitor, may ameliorate the inflammatory manifestations associated with severe COVID-19 and thus improve clinical outcomes.
METHODS:

Retrospective review of patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow up.
RESULTS:

Twenty-five patients were included, median age was 58 years (IQR 50-63) and the majority were males (92%). Co-morbidities included diabetes mellitus (48%), chronic kidney disease (16%) and cardiovascular disease (12%). Fever (92%), cough (84%) and dyspnoea (72%) were the commonest presenting symptoms. All patients received at least two concomitant investigational antiviral agents. Median oral temperature was on Day 1, Day 3 and Day 7 was 38.0oC, 37.3oC (P 0.043) and 37.0oC (P 0.064), respectively. Corresponding median CRP was 193 mg/L, 7.9 mg/L (P <0.0001) and <6 mg/L (P 0.0001). Radiological improvement was noted in 44% of patients by Day 7 and 68% by Day 14. Nine patients (36%) were discharged alive from ICU and three (12%) died. The proportion of patients on invasive ventilation declined from (84%) at the time of tocilizumab initiation to 60% on Day 7 (P 0.031) and 28% on Day 14 (P 0.001). The majority (92%) of patients experienced at least one adverse event. However, it is not possible to ascertain which adverse events were directly related to tocilizumab therapy.
CONCLUSION:

In patients with severe COVID-19, tocilizumab was associated with dramatic decline in inflammatory markers, radiological improvement and reduced ventilatory support requirements. Given the study's limitations, the results require assessment in adequately powered randomized controlled trials. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.



KEYWORDS:

COVID-19; IL-6; SARS-CoV-2; coronavirus; tocilizumab


PMID:32369191DOI:10.1002/jmv.25964