tetano
Editor, Senior Moderator
J Clin Med
. 2021 Apr 9;10(8):1583.
doi: 10.3390/jcm10081583.
Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6
Robert Flisiak[SUP] 1 [/SUP], Jerzy Jaroszewicz[SUP] 2 [/SUP], Magdalena Rogalska[SUP] 1 [/SUP], Tadeusz ?api?ski[SUP] 1 [/SUP], Aleksandra Berkan-Kawi?ska[SUP] 3 [/SUP], Beata Bolewska[SUP] 4 [/SUP], Magdalena Tudrujek-Zdunek[SUP] 5 [/SUP], Dorota Kozielewicz[SUP] 6 [/SUP], Marta Rorat[SUP] 7 8 [/SUP], Piotr Leszczy?ski[SUP] 9 10 [/SUP], Krzysztof K?os[SUP] 11 [/SUP], Justyna Kowalska[SUP] 12 [/SUP], Pawe? Pabjan[SUP] 13 [/SUP], Anna Piekarska[SUP] 3 [/SUP], Iwona Mozer-Lisewska[SUP] 4 [/SUP], Krzysztof Tomasiewicz[SUP] 5 [/SUP], Ma?gorzata Paw?owska[SUP] 6 [/SUP], Krzysztof Simon[SUP] 14 [/SUP], Joanna Polanska[SUP] 15 [/SUP], Dorota Zar?bska-Michaluk[SUP] 13 [/SUP]
Affiliations
Abstract
Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio
: 0.21, 95% confidence interval [CI]: 0.08-0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ? 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ? 90%.
Keywords: COVID-19; SARS-CoV-2; interleukin-6; therapy; tocilizumab.
. 2021 Apr 9;10(8):1583.
doi: 10.3390/jcm10081583.
Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6
Robert Flisiak[SUP] 1 [/SUP], Jerzy Jaroszewicz[SUP] 2 [/SUP], Magdalena Rogalska[SUP] 1 [/SUP], Tadeusz ?api?ski[SUP] 1 [/SUP], Aleksandra Berkan-Kawi?ska[SUP] 3 [/SUP], Beata Bolewska[SUP] 4 [/SUP], Magdalena Tudrujek-Zdunek[SUP] 5 [/SUP], Dorota Kozielewicz[SUP] 6 [/SUP], Marta Rorat[SUP] 7 8 [/SUP], Piotr Leszczy?ski[SUP] 9 10 [/SUP], Krzysztof K?os[SUP] 11 [/SUP], Justyna Kowalska[SUP] 12 [/SUP], Pawe? Pabjan[SUP] 13 [/SUP], Anna Piekarska[SUP] 3 [/SUP], Iwona Mozer-Lisewska[SUP] 4 [/SUP], Krzysztof Tomasiewicz[SUP] 5 [/SUP], Ma?gorzata Paw?owska[SUP] 6 [/SUP], Krzysztof Simon[SUP] 14 [/SUP], Joanna Polanska[SUP] 15 [/SUP], Dorota Zar?bska-Michaluk[SUP] 13 [/SUP]
Affiliations
- PMID: 33918563
- DOI: 10.3390/jcm10081583
Abstract
Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio
: 0.21, 95% confidence interval [CI]: 0.08-0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ? 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ? 90%.
Keywords: COVID-19; SARS-CoV-2; interleukin-6; therapy; tocilizumab.