Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series

Abstract

Objective: To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. Design: A retrospective case series Setting: Five community hospitals within 1 urban health system Patients: Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. Interventions: None. Measurements and Main Results Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 – 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. Conclusions: Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.

Specific Interleukin-1 Inhibitors, Specific Interleukin-6 Inhibitors, and GM-CSF Blockades for COVID-19 (at the Edge of Sepsis): A Systematic Review

“…Following the elimination of duplicates and screening of titles and abstracts, we evaluated 244 articles in full text. Among these, we found 43 eligible articles (5 RCTs, 16 cohort studies, 2 case-control studies, and 20 case reports) (Figure 1) (Salvarani et al, 2021;REMAP-CAP Investigators et al, 2021;Canziani et al, 2020;Menzella et al, 2020;Fisher et al, 2021;Campochiaro et al, 2020;Vazquez Guillamet et al, 2021;Rajendram et al, 2021;Huang et al, 2021;Galván-Román et al, 2021;Saffo et al, 2021;Somers et al, 2021;Brosnahan et al, 2021;Corominas et al, 2021;Cavalli et al, 2021;Abe et al, 2021;Patel et al, 2020;Mady et al, 2020;Bernardo et al, 2020;Morillas et al, 2020;Cascella et al, 2020;Al-Kaf et al, 2021;Eroglu et al, 2021;Kataoka et al, 2021;Kishaba et al, 2021;Leelayuwatanakul et al, 2021;McKenzie et al, 2021;Nourié et al, 2021;Ladna et al, 2021;Senegaglia et al, 2021;Thammathiwat et al, 2021;Lescure et al, 2021;Della-Torre et al, 2020;Gremese et al, 2020;Kyriazopoulou et al, 2021a;Bozzi et al, 2021;Franzetti et al, 2021;…”

Literature Review Efektivitas Penggunaan Tocilizumab Pada Pasien Covid-19

“…Terdapat 16 jurnal (tabel 1) sesuai kriteria yang menunjukkan efektivitas dari penggunaan tocilizumab, seluruh jurnal tersebut menunjukkan penurunan yang cukup signifikan pada parameter laboratorium. Tocilizumab yang diberikan setelah pemberian terapi standar menunjukkan penurunan angka CRP, feritin, d-dimer, LDH, limfosit, dan IL-6 dibandingkan sebelum pemberian (Amin et al, 2021;Bhandari et al, 2021;Birlutiu et al, 2021;Burlacu et al, 2021;Chachar et al, 2021;Chamorro-de-Vega et al, 2021;Corominas et al, 2021;Diaz, 2021;Li et al, 2021;Masci et al, 2021;McKenzie et al, 2021;Mussini et al, 2021;Sarhan et al, 2021;Soin et al, 2021).…”

Tocilizumab in Severe and Critical COVID-19 Pneumonia: Streamlining the Mixed Signals

“…5,6 It is therefore not surprising that multiple therapeutic trials done targeting specific cytokines such as IL-6 and TNF-a have also led to mixed results. [7][8][9][10] Since 2020, aggressive research has allowed both the development of new medications as well as repurposing of other molecules in the treatment of COVID-19. Antiviral drugs, monoclonal antibodies, IL-6R inhibitor/immune modulators, and systemic corticosteroids have become household names.…”

“…[5][6][7] If mechanistically, IL-6 blockers, particularly tocilizumab can block the inflammatory cascade, why are there mixed signals on its benefit based on real-world evidence? [7][8][9][10] One of the largest and most recently published systematic review and meta-analysis of 15 randomized and two nonrandomized clinical trials evaluating the effect of tocilizumab on the clinical outcomes of COVID-19 patients 11 showed a combined cumulative risk of death in COVID-19 patients of 0.93 (RR 0.93, 95% CI 0.86 -1.00, i 2 72.39%). The need for invasive ventilation, ICU admission was at 1.04 (RR 1.04, 95% CI 0.90 -1.20, i 2 0.00).…”