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J Med Virol
. 2020 Aug 13.
doi: 10.1002/jmv.26429. Online ahead of print.
Late Onset Infectious Complications and Safety of Tocilizumab in the Management of COVID-19
Natasha N Pettit 1 , Cynthia T Nguyen 1 , G?khan M Mutlu 2 , David Wu 2 , Lucas Kimmig 2 , David Pitrak 3 , Kenneth Pursell 3
Affiliations
- PMID: 32790075
- DOI: 10.1002/jmv.26429
Abstract
Background: Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug-related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID-19 patients.
Methods: All adult inpatients with COVID-19 between March 1st and April 25th , 2020 that received TCZ were included. We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions.
Results: Seventy-four patients were included in each group. Seven-teen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (p=0.013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, p=0.03).
Conclusion: Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use. This article is protected by copyright. All rights reserved.
Keywords: Coronavirus < Virus classification; Cytokine/Chemokine < Immune responses; SARS coronavirus < Virus classification.