tetano
Editor, Senior Moderator
BMC Infect Dis
. 2020 Dec 22;20(1):964.
doi: 10.1186/s12879-020-05701-4.
Effects of Tocilizumab in COVID-19 patients: a cohort study
Christine A Vu[SUP] 1 2 [/SUP], Kailynn J DeRonde[SUP] 3 [/SUP], Ana D Vega[SUP] 3 [/SUP], Meshell Maxam[SUP] 3 [/SUP], Gregory Holt[SUP] 4 [/SUP], Yoichiro Natori[SUP] 5 [/SUP], Jose Gonzales Zamora[SUP] 5 [/SUP], Veronica Salazar[SUP] 3 [/SUP], Renata Boatwright[SUP] 3 [/SUP], Stephen R Morris[SUP] 5 [/SUP], Daniela de Lima Corvino[SUP] 5 [/SUP], Anmary Fernandez Betances[SUP] 5 [/SUP], Leah Colucci[SUP] 6 [/SUP], James Keegan[SUP] 6 [/SUP], Andy Lopez[SUP] 6 [/SUP], Andrew Hany Rezk[SUP] 6 [/SUP], Yvette Rodriguez[SUP] 6 [/SUP], Gabriela M Moraru[SUP] 7 [/SUP], Susanne Doblecki[SUP] 5 [/SUP], David J De La Zerda[SUP] 4 [/SUP], Lilian M Abbo[SUP] 5 [/SUP]
Affiliations
Abstract
Background: Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2.
Methods: A retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020.
Results: Most patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1-21) after initial symptoms and 2 days (range 0-12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] and an initial reduction in CRP, but this effect was not sustained beyond day 10.
Conclusions: Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.
Keywords: COVID-19; Coronavirus; Cytokine release syndrome; Tocilizumab.
. 2020 Dec 22;20(1):964.
doi: 10.1186/s12879-020-05701-4.
Effects of Tocilizumab in COVID-19 patients: a cohort study
Christine A Vu[SUP] 1 2 [/SUP], Kailynn J DeRonde[SUP] 3 [/SUP], Ana D Vega[SUP] 3 [/SUP], Meshell Maxam[SUP] 3 [/SUP], Gregory Holt[SUP] 4 [/SUP], Yoichiro Natori[SUP] 5 [/SUP], Jose Gonzales Zamora[SUP] 5 [/SUP], Veronica Salazar[SUP] 3 [/SUP], Renata Boatwright[SUP] 3 [/SUP], Stephen R Morris[SUP] 5 [/SUP], Daniela de Lima Corvino[SUP] 5 [/SUP], Anmary Fernandez Betances[SUP] 5 [/SUP], Leah Colucci[SUP] 6 [/SUP], James Keegan[SUP] 6 [/SUP], Andy Lopez[SUP] 6 [/SUP], Andrew Hany Rezk[SUP] 6 [/SUP], Yvette Rodriguez[SUP] 6 [/SUP], Gabriela M Moraru[SUP] 7 [/SUP], Susanne Doblecki[SUP] 5 [/SUP], David J De La Zerda[SUP] 4 [/SUP], Lilian M Abbo[SUP] 5 [/SUP]
Affiliations
- PMID: 33353546
- DOI: 10.1186/s12879-020-05701-4
Abstract
Background: Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2.
Methods: A retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020.
Results: Most patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1-21) after initial symptoms and 2 days (range 0-12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] and an initial reduction in CRP, but this effect was not sustained beyond day 10.
Conclusions: Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.
Keywords: COVID-19; Coronavirus; Cytokine release syndrome; Tocilizumab.