Notes from the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient with Severe COVID-19 and Cytokine Release Syndrome

Ali, Sabahat; Khalid, Sundas; Afridi, Maham; Akhtar, Samar; Khader, Yousef; Akhtar, Hashaam

doi:10.2196/27609

Cited by 4 publications

(2 citation statements)

References 33 publications

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“…Additional treatment with a course of dexamethasone or equivalent is further recommended. One patient with a SARS-CoV-2-induced cytokine release syndrome was successfully treated with a combination of tocilizumab and remdesivir [29]. Initial studies showed conflicting results and no significant difference in mortality or clinical status between tocilizumab-treated and placebo groups.…”

Section: Tocilizumabmentioning

confidence: 99%

Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children

Edinoff

Alpaugh

Newgaard

et al. 2023

Life

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Coronavirus disease 2019 (COVID-19) rapidly emerged as a global pandemic, placing imminent stress and burden on healthcare resources and workers worldwide. Many patients who present with a severe COVID-19 infection are at high risk of developing severe acute respiratory distress syndrome (ARDS), leading to a vast number of patients requiring mechanical ventilation and a high mortality rate. Similar to Middle East respiratory syndrome, COVID-19 demonstrates an initial viral replication phase that manifests as a variety of symptoms typically flu-like in nature, followed by a profound inflammatory response leading to rapid production of cytokines and uncontrolled inflammation. There have also been many cases of COVID-19 in pediatric patients presenting with elevated inflammatory markers and multisystem involvement labeled as a multisystem inflammatory syndrome (MIS-C) by the world health organization (WHO). The recent treatment of systemic inflammatory response to COVID-19 targets the secondary phase involving cytokine release syndrome. The detrimental effects of IL-6 can be profound and elevated levels are associated with a higher mortality rate and mechanical ventilation. Tocilizumab is an IL-6 inhibitor most widely investigated to target cytokine storm syndrome. Since June 2021, the FDA enacted an emergency use authorization for tocilizumab in the treatment of COVID-19. Several clinical trials have investigated tocilizumab combined with corticosteroids for treating severe ARDS associated with COVID-19. An increasing amount of evidence suggests that targeting the cytokine storm syndrome related to COVID-19 can lead to improved outcomes, especially in those patients requiring mechanical ventilation and with a critical illness. Additional studies are warranted to further look at the positive effects of tocilizumab in the COVID-19 population while additionally defining possible adverse effects.

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Section: Tocilizumabmentioning

confidence: 99%

Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children

Edinoff

Alpaugh

Newgaard

et al. 2023

Life

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“…In this condition, remdesivir monotherapy is frequently ineffective, but the combination of remdesivir with antibody-based therapeutics holds promise. Remdesivir, combined with tocilizumab (an anti-interleukin-6 monoclonal antibody) and dexamethasone, was administered at the early stage of the disease, resulting in timely resolution of the cytokine storm and subsequent improvement in ARDS symptoms and eventual recovery [155]. Combination of remdesivir with convalescent plasma or anti-SARS-CoV-2 monoclonal antibodies (mAbs) achieved high viral clearance [156,157].…”

Section: Combination Therapy With Biomacromolecule and Small Moleculementioning

confidence: 99%

Combination Therapies against COVID-19

Luo¹,

Zheng²,

Zhang³

2022

Front. Biosci. (Landmark Ed)

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of Coronavirus disease 2019 (COVID-19), which was announced as a pandemic leading to devastating economic and medical burden worldwide. The virus attacks the organ system across the body by binding to its receptor (for example, angiotensin converting enzyme 2) on the surface of the host cell of various organs. The patients present with a variety of pathological symptoms ranging from fever, cough and cytokine storm to acute respiratory distress syndrome (ARDS). Many combination therapies have been developed to combat the disease, via blocking one or more processes of the viral life cycle and/or relieving host complications simultaneously. In this review, the progress of those combination therapies containing at least one small molecule is updated. We believe it'll provide significant inspiration for further development of treatment strategy against SARS-CoV-2, especially its mutant variants.

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Therapeutic Efficacy and Outcomes of Remdesivir versus Remdesivir with Tocilizumab in Severe SARS-CoV-2 Infection

Vulturar

Neag

Vesa

et al. 2022

IJMS

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The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) generated many challenges to find an effective drug combination for hospitalized patients with severe forms of coronavirus disease 2019 (COVID-19) pneumonia. We conducted a retrospective cohort study, including 182 patients with severe COVID-19 pneumonia hospitalized between March and October 2021 in a Pneumology Hospital from Cluj-Napoca, Romania. Among patients treated with standard of care, 100 patients received remdesivir (R group) and 82 patients received the combination of remdesivir plus tocilizumab (RT group). We compared the clinical outcomes, the inflammatory markers, superinfections, oxygen requirement, intensive care unit (ICU) admission and mortality rate before drug administration and 7 days after in R group and RT group. Borg score and oxygen support showed an improvement in the R group (p < 0.005). Neutrophiles, C-reactive protein (CRP) and serum ferritin levels decreased significantly in RT group but with a higher rate of superinfection in this group. ICU admission and death did not differ significantly between groups. The combination of remdesivir plus tocilizumab led to a significantly improvement in the inflammatory markers and a decrease in the oxygen requirement. Although the superinfection rate was higher in RT group than in R group, no significant difference was found in the ICU admission and mortality rate between the groups.

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Notes from the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient with Severe COVID-19 and Cytokine Release Syndrome

Cited by 4 publications

References 33 publications

Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children

Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children

Combination Therapies against COVID-19

Therapeutic Efficacy and Outcomes of Remdesivir versus Remdesivir with Tocilizumab in Severe SARS-CoV-2 Infection

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