Tocilizumab exerts anti-inflammatory activity in six critically ill COVID-19 patients: a retrospective analysis

Abstract

Background: Coronavirus disease 2019 has become a worldwide pandemic, affecting countries across the globe. With no current vaccine, treatment is still a critical intervention for minimizing morbidity and preventing disease-specific mortality. This study aimed to assess the clinical outcomes of critically ill COVID-19 patients using Tocilizumab treatment to provide recommendations for the treatment of COVID-19 patients with severe disease. Methods: This was a retrospective analysis of medical records of six critically ill patients admitted to the Third People's Hospital of Shenzhen, China, from January 11 to February 26, 2020. Patient-related outcomes, including demographic, clinical, and laboratory characteristics before and after the initiation of Tocilizumab, were descriptively analyzed. Four to eight milligrams (mg)/kilogram (kg) of Tocilizumab was prescribed, with Chinese treatment guidelines. Results: By the end of the last follow-up, Patient 1 and Patient 2 developed complications and died after using Tocilizumab for three to four days. Patient 4 died of multiple organ failure caused by cerebral infarction after using Tocilizumab for 39 days. Patient 3 and Patient 6 were discharged after 29 days and 33 days on Tocilizumab, respectively. Clinical symptoms, including fever, heart rate, and oxygen levels, improved after Tocilizumab use. Two patients appeared transient abnormal of liver or renal function indicator, and they can gradually recover. All elevated serum levels of inflammatory factors gradually decreased, except in Patient 2. Patient 3 and Patient 6's inflammatory lesions also significantly improved after initiating Tocilizumab.Conclusions: Anti-inflammatory treatment with Tocilizumab was found to improve inflammatory responses in critically ill COVID-19 patients. Although some side reactions will occur, patients can gradually recover without affecting the efficacy of the therapy. However, the proper timing to start patients on Tocilizumab patients should be explored. Further prospective, randomized controlled clinical trials are called for.

Repurposing clinically available drugs and therapies for pathogenic targets to combat SARS‐CoV‐2

“…A number of preclinical and clinical studies have confirmed the safety and efficacy of the IL6 antibody, siltuximab, and the IL6R antibodies, tocilizumab and sarilumab, showed promise in decreasing cytokine levels, ameliorating symptoms of systemic toxicity, and reducing the requirements for adjuvant and other therapies, including vasoactive drugs, glucocorticoids and respiratory support. 139 , 140 , 141 , 142 There are presently more than 30 trials investigating tocilizumab for treatment of SARS‐CoV‐2. Tocilizumab has been used for treatment of cytokine storms.…”

“…Through blocking cytokine production, ameliorating the symptoms of systemic toxicity, and reducing the requirements for adjuvant and other therapies, this antibody has shown high efficacy and safety in a series of preclinical and clinical studies involving SARS‐CoV‐2. 140 , 142 , 144 , 388 Up to now, there have been more than 30 SARS‐CoV‐2 trials (NCT04445272, NCT04730323, NCT04331795, so on) investigating tocilizumab as a COVID‐19 therapeutic. On June 24, 2021, tocilizumab was approved by the US FDA for the treatment of hospitalized adults and pediatric patients (over two years old) with severe symptoms of COVID‐19 (FDA News Release).…”

Epigenetic underpinnings of inflammation: Connecting the dots between pulmonary diseases, lung cancer and COVID-19

“…Even in children and adolescents, the so called ‘low-risk’ categories for COVID-19, inflammation- associated aggressive form of COVID-19 has been reported [ 45 ]. Clinical resolution of inflammation can possibly impact the survival of COVID-19 patients [ 46 ]. Several studies have indicated that SARS-CoV-2 causes injury predominantly through host immune dysregulation, increase in inflammation and/or hyperinflammation leading to severity of the disease, resulting in high rate of hospitalizations and mortality.…”

Immunoregulatory therapy strategies that target cytokine storms in patients with COVID‑19 (Review)

“…A number of studies have confirmed the safety and efficacy of the anti-IL-6 antibody siltuximab, and the anti-IL-6R antibodies tocilizumab and sarilumab (25)(26)(27). To date, more than 40 clinical trials using anti-IL-6 or anti-IL-6R treatments have commenced for patients with COVID-19, including more than 30 trials using tocilizumab (Table I).…”