Tocilizumab treatment in COVID‐19: A single center experience

Abstract

Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms recently.In the present study, we aimed to discuss the treatment response of TCZ therapy in COVID-19 infected patients. The demographic, treatment, laboratory parameters of C-reactive protein (CRP) and IL-6 before and after TCZ therapy and clinical outcome in the 15 COVID-19 patients were retrospectively assessed. Totally 15 patients with COVID-19 were included in this study. Two of them were moderately ill, six were seriously ill and seven were critically ill. The TCZ was used in combination with methylprednisolone in eight patients. Five patients received the TCZ administration twice or more. Although TCZ treatment ameliorated the increased CRP in all patients rapidly, for the four critically ill patients who received an only single dose of TCZ, three of them (No. 1, 2, and 3) still dead and the CRP level in the rest one patient (No. 7) failed to return to normal range with a clinical outcome of disease aggravation. Serum IL-6 level tended to further spiked firstly and then decreased after TCZ therapy in 10 patients. A persistent and dramatic increase of IL-6 was observed in these four patients who failed treatment. TCZ appears to be an effective treatment option in COVID-19 patients with a risk of cytokine storms. And for these critically ill patients with elevated IL-6, the repeated dose of the TCZ is recommended.

Recognition and management of respiratory co-infection and secondary bacterial pneumonia in patients with COVID-19

“…• CRP and ESR are non-specifi c infl ammatory markers. Both are generally elevated in COVID-19 and are therefore not helpful in differentiating this from bacterial infection • Tocilizumab rapidly reduces CRP and leukocytosis and may suppress fever [24][25][26] Typical radiographic features COVID-19 • Chest radiography: Bilateral, peripheral, lower-zone predominant air-space disease 27 • Computed tomography: Bilateral, predominantly peripheral ground glass opacities, crazy-paving and consolidation 28 ; fi ndings vary based on stage/phase of the disease Bacterial pneumonia • Chest radiography: Lobar or segmental air-space opacifi cation ± air bronchograms • Computed tomography: Segmental or lobar focal dense consolidation ± ground-glass opacities on May 23, 2020. For personal use only.…”

May IL-17 have a role in COVID-19 infection?

“…COVID-19 patients showed lower leukocyte numbers, abnormal respiratory findings, and increased levels of plasma pro-inflammatory cytokines such as interleukin (IL)1-β, IL1RA, IL6, IL8, IL10 with Th1-Th17 cells appearing as the main source [3]. That is why recently tocilizumab, a monoclonal antibody blocking IL-6 action has been shown to be effective in COVID-19 subjects with cytokine storm risk [4]. Indeed, proinflammatory cytokine storms have been observed in critically COVID-19 patients which progress to multiple organ dysfunction and death [4,5].…”

“…That is why recently tocilizumab, a monoclonal antibody blocking IL-6 action has been shown to be effective in COVID-19 subjects with cytokine storm risk [4]. Indeed, proinflammatory cytokine storms have been observed in critically COVID-19 patients which progress to multiple organ dysfunction and death [4,5]. Therefore, cytokine storms early treatment and prevention is of crucial importance.…”

Implications of COVID-19 for the management of patients with inflammatory rheumatic diseases

“…The main concern of physicians caring for patients with inflammatory disease treated with immune-targeted therapies is the risk of potentially increased severity in these patients, including the risk of severe pneumonia. However, initial results have highlighted the impact of cardiovascular and pulmonary comorbidities [10] rather than that of possible immunosuppression, leading some to even consider a protective role for immunosuppressive drugs in severe pneumonia [11][12][13]. The limited information currently available comes from a Chinese cohort of 20,000 patients with chronic inflammatory bowel diseases, and from 3 hospitals in Wuhan: no cases of infected patients have been reported [14].…”

“…The evidence of very high concentrations of inflammatory cytokines in the plasma and bronchoalveolar lavage fluid of intensive care in patients compared to other patients justified a strategy of using biotherapies (tocilizumab, adalimumab). An open-label clinical trial has been published, suggesting, on a cohort of 15 patients, the efficacy of tocilizumab on the cytokine storm potentially responsible for acute respiratory distress syndrome [13]. Other drugs, well known among specialists in inflammatory diseases such as hydroxychloroquine [12] and baricitinib [11], could limit the entry of the virus into the cell and ultimately reduce the viral load.…”