Depression, Anxiety, and Quality of Life in Patients Treated with Single Infusion Tocilizumab for COVID-19: A Follow-up, Controlled Study

Abstract

Background: The inflammatory state that characterizes COVID-19 may contribute to depression, anxiety, other morbidities, and mortality. Interleukin-6 blocker tocilizumab has been used as a treatment modality in COVID-19 as an anti-inflammatory agent. Tocilizumab has also been studied for its potential use in preventing depression in other patient groups, with mixed results. This study was designed to study subsequent depression, anxiety, and quality of life (QOL) in patients treated with tocilizumab plus standard care versus standard care alone, for moderate to severe COVID-19 pneumonia. Methods: Patients admitted with moderate to severe COVID pneumonia, treated with tocilizumab plus standard treatment, and discharged from the hospital were identified. Age- and gender-matched controls who had received standard treatment alone for COVID-19 pneumonia during the same time frame were identified. After obtaining consent, these patients were followed up and assessed at 3 and 6 months on measures of depression (PHQ-9), anxiety (GAD-7), and QOL (EQ-5D-5L). Results: 39 patients in the tocilizumab group and 41 in the control group were followed up at 3 and 6 months. Patients in both groups were comparable in sociodemographic and clinical parameters. The prevalence of clinically significant depression in the tocilizumab group at 3 and 6 months was 33.33% and 5.12%, respectively, whereas in control group it was 31.7% and 4.87%, respectively. Analysis of EQ-5D health profiles revealed that the maximum problems were reported in the dimension of mobility: 43.7% at 3 months and 35% at 6 months. Conclusions: Depressive and anxiety symptoms and impairment in QOL were reported more frequently and with greater severity in patients in the tocilizumab group at three months but not at six months. Psychological morbidity and impairment in QOL were modest and improved from 3 to 6 months.

Comment on: ‘Should We Interfere with the Interleukin-6 Receptor During COVID-19: What Do We Know?’

“…These observations should again raise attention concerning the appropriateness of using IL-6 receptor inhibitors in patients with COVID-19, given that these agents would raise the serum level of IL-6, which can predispose to the development of long COVID [ 5 ]. Our hypothesis is supported by a recent study [ 6 ] investigating the subsequent development of depression and anxiety, and quality of life in patients with moderate to severe COVID-19 treated with tocilizumab versus no tocilizumab. It was observed that patients in the tocilizumab group had significantly more depressive and anxiety symptoms, and a worse quality of life than the controls at a 3-month follow-up.…”

Effect of Anti-Interleukin-6 Agents on Psychopathology in a Sample of Patients with Post-COVID-19 Syndrome: An Observational Study

“…Another study was carried out in patients with moderate to severe COVID-19-related pneumonia after their discharge. Subjects receiving tocilizumab in adjunct to the standard treatment showed marginally worse levels of depression than those undergoing the standard treatment only at the 3-month follow-up, whereas an absence of depression was observed at the 6-month follow-up [47]. Sarilumab has not been assessed for its effects on depression, but one study on subjects with rheumatoid arthritis showed more effectiveness on depression as compared to adalimumab [48].…”