tetano
Editor, Senior Moderator
Eur J Rheumatol
. 2022 Feb 14.
doi: 10.5152/eurjrheum.2022.21010. Online ahead of print.
What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome?
Cansu Akleylek[SUP] 1 [/SUP], Seray Gizem Gür[SUP] 2 [/SUP], İbrahim Halil Sever[SUP] 2 [/SUP], Safiye Koçulu Demir[SUP] 3 [/SUP], Esin Çevik[SUP] 4 [/SUP], Egemen Eken[SUP] 5 [/SUP], Zafer Gökkaya[SUP] 5 [/SUP], Yonca Çağatay[SUP] 6 [/SUP], Neslihan Yılmaz[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.
Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.
Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).
Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.
. 2022 Feb 14.
doi: 10.5152/eurjrheum.2022.21010. Online ahead of print.
What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome?
Cansu Akleylek[SUP] 1 [/SUP], Seray Gizem Gür[SUP] 2 [/SUP], İbrahim Halil Sever[SUP] 2 [/SUP], Safiye Koçulu Demir[SUP] 3 [/SUP], Esin Çevik[SUP] 4 [/SUP], Egemen Eken[SUP] 5 [/SUP], Zafer Gökkaya[SUP] 5 [/SUP], Yonca Çağatay[SUP] 6 [/SUP], Neslihan Yılmaz[SUP] 1 [/SUP]
Affiliations
- PMID: 35156638
- DOI: 10.5152/eurjrheum.2022.21010
Abstract
Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.
Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.
Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).
Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.
