Early use of low dose tocilizumab in patients with COVID-19: A retrospective cohort study with a complete follow-up

Abstract

Background Pneumonia with severe respiratory failure represents the principal cause of death in COVID-19, where hyper-inflammation plays an important role in lung damage. An effective treatment aiming at reducing the inflammation without preventing virus clearance is thus urgently needed. Tocilizumab, an anti-soluble IL-6 receptor monoclonal antibody, has been proposed for treatment of patients with COVID-19. Methods A retrospective cohort study at the Montichiari Hospital, Brescia, Italy, was conducted. We included consecutive patients with COVID-19 related pneumonia at the early stage of respiratory failure, all treated with a standard protocol (hydroxychloroquine 400 mg daily, lopinavir 800 mg plus ritonavir 200 mg per day). We compared survival rate and clinical status in a cohort of patients who received additional treatment with tocilizumab once (either 400 mg intravenous or 324 mg subcutaneous) with a retrospective cohort of patients who did not receive tocilizumab (referred to as the standard treatment group). All outcomes were assessed at the end of the follow-up, that correspond to death or complete recovery and discharge from the hospital. Findings 158 patients were included, 90 of which received tocilizumab. 34 out of 68 (50%) patients in the standard treatment group and 7 out of 90 (7.7%) in the tocilizumab group died. Tocilizumab significantly improved survival compared to standard care (multivariate HR: 0.057; 95% C.I = 0.017- 0.187, p < 0.001). No differences between the two administration routes of tocilizumab were observed. No tocilizumab-related infections and/or side effects were observed. Interpretation Early treatment with tocilizumab could be helpful to prevent excessive hyper-inflammation and death in COVID-19 related pneumonia. Low dose administration of tocilizumab is not associated with adverse events. Funding none

Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

“…In a subgroup of patients with severe respiratory distress intravenous corticosteroids (dexamethasone 20 mg intravenously -i.v per day for 5 days and then 10 mg i.v. per day for 5 days) were used (19), while another subgroup of patients received off-label a single low dose administration of the anti-interleukin-6 monoclonal antibody tocilizumab (8 mg/kg mg i.v-or 324 mg subcutaneous -s.c.-depending on the drug availability) in addition to Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20203455/897588/bsr-2020-3455-t.pdf by guest on 26 November 2020 standard therapy (20). During hospitalization, patients in both groups were assisted with noninvasive (i.e.…”

Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: A retrospective cohort study with follow-up from Mumbai, India

“…Nicola et al 7 used tocilizumab in patients with peripheral Oxygen saturation 93% on room air or PaO2/FiO2 less than 300mm of Hg, and documented reduction in mortality from 50% to 7.7%. With early use of tocilizumab, Nicola et al 8 could reduce risk of death by 94%. Although more than 70% of our admitted patients were hypoxic (Oxygen saturation less than 95% on ambient air) during hospital stay, the limited availability of tocilizumab made it mandatory for us to formulate strict inclusion criteria for tocilizumab administration.…”

Medicamentos e tratamentos para a Covid-19

“…Mudando o foco para os medicamentos biológicos, os anticorpos monoclonais são os mais explorados em ensaios clínicos para a Covid-19 (Cohen, 2020;Florindo et al, 2020). O tocilizumabe, um anticorpo monoclonal humano recombinante, tem sido muito estudado com a finalidade de reduzir a intensa resposta inflamatória ao vírus em pacientes graves, conhecida como tempestade de citocinas (De Rossi et al, 2020). As citocinas são proteínas que regulam a resposta imunológica, e a tempestade de citocinas é exatamente uma resposta imunológica excessiva, que progride rapidamente causando muitos danos ao organismo, com alta mortalidade.…”