Tocilizumab for cytokine storm syndrome in COVID-19 pneumonia: an increased risk for candidemia?

Abstract

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Tocilizumab in the Management of COVID-19: A Preliminary Report

“…Because of some of these data, the agent was recommended by China's National Health Commission for use in COVID-19 patients with elevated IL-6 levels 20 . However, other reports failed to show improved mortality 21 and highlighted the potential adverse effects of Tocilizumab including toxic erythema, candidemia, and bowel perforation 22 , 23 , 24 . An “Interim Guidance on Management Pending Empirical Evidence Report published by the American Thoracic Society on April 3, 2020 did not make a recommendation in favor of or against Tocilizumab considering the limited and conflicting data available 25 .…”

A “Window of Therapeutic Opportunity” for Anti-Cytokine Therapy in Patients With Coronavirus Disease 2019

“…Although the therapeutic window in CRS is narrow, and timely control of the cytokine storm is crucial to reduce short-term mortality, premature use of immunosuppressants could indeed further compromise viral shedding with the risk of increasing viral replication and tissue damage directly induced by the virus ( 43 ). Furthermore, iatrogenic immunosuppression could promote bacterial, fungus, or viral infectious complications, as shown with the targeting of IL-6 with tocilizumab in observational studies on patients not requiring mechanical ventilation ( 18 , 55 ). Also at later stages, pharmacologically induced immunosuppression in already immunocompromised patients could adversely affect the course of the disease, as suggested by the finding of significantly longer periods of hospitalization and higher rates of mortality in ventilated patients treated with tocilizumab ( 15 , 16 ) or high-doses corticosteroids ( 56 , 57 ).…”

COVID-19 and clinical pharmacology

“…Риск развития серьезных нежелательных явлений при лечении моноклональными антителами также хорошо известен, а система фармаконадзора для них требует особых условий [61]. Опубликованы данные о высокой частоте развития грибковых инфекций при применении моноклональных антител к рецепторам ИЛ-6 при COVID-19 [62].…”