Clinical Outcomes Following Tocilizumab Administration in Mechanically Ventilated Coronavirus Disease 2019 Patients

Sirimaturos, Michael; Gotur, Deepa; Patel, Samir J.; Dreucean, Diane; Jakowenko, Nicholas; Cooper, Megan H; Brahmbhatt, Nishal; Graviss, Edward A.; Nguyen, Duc T.; Pingali, Sai Ravi; Lin, Jiejian; Musick, William L.

doi:10.1097/cce.0000000000000232

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…Several observational and randomised clinical trials (RCTs) show conflicting results on the effectiveness of TCZ in moderate, severe, and critical COVID-19. Multiple observational studies and meta-analyses show increased survival in patients treated with TCZ and supportive therapy [ [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. In contrast, a recent publication of four randomised placebo-controlled trials shows no difference in mortality compared with standard of care or a placebo.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of tocilizumab in patients with severe COVID-19: Survival and clinical outcomes

Albaadani

Eltayeb

Alsufyani

et al. 2021

Journal of Infection and Public Health

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Background SARS-CoV-2 is associated with a severe inflammatory response contributing to respiratory and systemic manifestations, morbidity, and mortality in patients with coronavirus disease 2019 (COVID-19). Methods Tocilizumab (TCZ) efficacy on mortality and length of hospital stay was retrospectively evaluated in patients who received TCZ and compared with that in controls with a similar severity of COVID-19. The primary endpoint was survival probability on day 28. The secondary endpoints included survival at day 14 and length of hospital stay. Results Of the 148 patients included in the study, 62 received TCZ and standard of care, whereas 86 served as a control group and received only standard of care. The two groups were similar, although TCZ-treated patients were more likely to exhibit hypertension (46.7% vs. 29.8%), chronic kidney disease (14.5% vs. 1.1%), and high Charlson score (1.18 vs. 1.00; p = 0.006) and less likely to receive corticosteroid treatment (48.5% vs. 93.0%). TCZ was associated with lower mortality on both day 28 (16.1% vs. 37.2%, p = 0.004) and day 14 (9.7% vs. 24.4%, p = 0.022). The hospital stay was longer in the TCZ-treated than in the control group (15.6 ± 7.59 vs.17.7 ± 7.8 days, p = 0.103). Ten patients (16.0%) in the TCZ-treated group developed infections. Conclusion TCZ was associated with a lower likelihood of death despite resulting in higher infection rates and a non-significant longer hospital stay.

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Section: Introductionmentioning

confidence: 99%

“…Studies from different geographic zones have yielded different treatment outcomes and mortality rates [ 10 ]. The aim of the current study was to describe the clinical, laboratory, and radiological characteristics of severe/critical COVID-19 and the outcome after TCZ in Saudi Arabia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of tocilizumab in patients with severe COVID-19: Survival and clinical outcomes

Albaadani

Eltayeb

Alsufyani

et al. 2021

Journal of Infection and Public Health

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“…In contrast, an observational study of 62 mechanically ventilated, COVID-19-positive patients demonstrated clinical improvement in 36 patients (58%) by 21 days post TCZ. 13 …”

Section: Discussionmentioning

confidence: 99%

“…In contrast, an observational study of 62 mechanically ventilated, COVID-19-positive patients demonstrated clinical improvement in 36 patients (58%) by 21 days post TCZ. 13 In another retrospective study by Luo and colleagues, 14 the authors recommended TCZ as an effective treatment option for patients with COVID-19 with high risk of cytokine storm. They also recommended a repeat dose of TCZ for critically ill patients with elevated IL-6 levels.…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab for the Treatment of COVID-19-Induced Cytokine Storm and Acute Respiratory Distress Syndrome: A Case Series From a Rural Level 1 Trauma Center in Western Pennsylvania

Suresh

Figart

Formeck

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, initially in December 2019 at Wuhan, China, subsequently spread around the world. We describe a case series of COVID-19 patients treated at our academic medical center with focus on cytokine storm and potential therapeutic role of tocilizumab. A 59-year-old female admitted for shortness of breath (SOB), productive cough, fever, and nausea in the setting of COVID-19 pneumonia. Oxygen saturation was 81% necessitating supplemental oxygen. She was transferred to intensive care unit (ICU) for worsening hypoxia; intubated and received tocilizumab following which her oxygen requirements improved. A 52-year-old female admitted from an outside hospital with SOB, intubated for worsening hypoxia, in the setting of COVID-19 pneumonia. She received tocilizumab 400 mg intravenous for 2 doses on ICU admission, with clinical improvement. A 56-year-old female hospitalized with worsening SOB, fever, and cough for 8 days saturating 88% on room air in the setting of COVID-19 pneumonia. Worsening hypoxia necessitated high flow nasal cannula. She was transferred to the ICU where she received 2 doses of tocilizumab 400 mg intravenous. She did not require intubation and was transitioned to nasal cannula. A hyperinflammatory syndrome may cause a life-threatening acute respiratory distress syndrome in patients with COVID-19 pneumonia. Tocilizumab is the first marketed interleukin-6 blocking antibody, and through targeting interleukin-6 receptors likely has a role in treating cytokine storm. We noted clinical improvement of patients treated with tocilizumab.

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“…Although tocilizumab group seemed to have improved survival outcome, these positive results need to be interpreted with caution since different research types and confounding factors (Wadud et al, 2020). Transient transaminitis was found to be the most common adverse reaction in patients 21 days post tocilizumab (Sirimaturos et al, 2020). However, no significant clinical improvement in temperature or oxygen requirements in most patients were observed in a US study (Rimland et al, 2020).…”

Section: Tocilizumabmentioning

confidence: 96%

Modalities and Mechanisms of Treatment for Coronavirus Disease 2019

Zuo

Pan

et al. 2021

Front. Pharmacol.

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Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly throughout the world. Although COVID-19 has a relatively low case severity rate compared to SARS and Middle East Respiratory syndrome it is a major public concern because of its rapid spread and devastating impact on the global economy. Scientists and clinicians are urgently trying to identify drugs to combat the virus with hundreds of clinical trials underway. Current treatments could be divided into two major part: anti-viral agents and host system modulatory agents. On one hand, anti-viral agents focus on virus infection process. Umifenovir blocks virus recognizing host and entry. Remdesivir inhibits virus replication. Chloroquine and hydroxychloroquine involve preventing the whole infection process, including virus transcription and release. On the other hand, host system modulatory agents are associated with regulating the imbalanced inflammatory reaction and biased immune system. Corticosteroid is believed to be commonly used for repressing hyper-inflammation, which is one of the major pathologic mechanisms of COVID-19. Convalescent plasma and neutralizing antibodies provide essential elements for host immune system and create passive immunization. Thrombotic events are at high incidence in COVID-19 patients, thus anti-platelet and anti-coagulation are crucial, as well. Here, we summarized these current or reproposed agents to better understand the mechanisms of agents and give an update of present research situation.

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Clinical Outcomes Following Tocilizumab Administration in Mechanically Ventilated Coronavirus Disease 2019 Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 26 publications

Efficacy of tocilizumab in patients with severe COVID-19: Survival and clinical outcomes

Efficacy of tocilizumab in patients with severe COVID-19: Survival and clinical outcomes

Tocilizumab for the Treatment of COVID-19-Induced Cytokine Storm and Acute Respiratory Distress Syndrome: A Case Series From a Rural Level 1 Trauma Center in Western Pennsylvania

Modalities and Mechanisms of Treatment for Coronavirus Disease 2019

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