Effects of Tocilizumab in COVID-19 patients: a cohort study

Abstract

Background Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2. Methods A retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020. Results Most patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1–21) after initial symptoms and 2 days (range 0–12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO2/FiO2 and an initial reduction in CRP, but this effect was not sustained beyond day 10. Conclusions Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.

Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

“…There was no significant difference in multivariable logistic regression analysis between the two groups regarding CRE detection (p = 0.34). Our results contradict those of a prospective observational study conducted to assess the predictors of superinfections in patients with COVID-19 [ 32 ]. This study showed that CRE caused 52 episodes of MDR infections and reported a significant difference (p = 0.001) between IL6 users and non-users in terms of superinfection rate.…”

Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis

“…A total of 204 records were excluded after screening the titles/abstracts because they did not match our inclusion and exclusion criteria. After evaluating 30 full-texts for eligibility, 5 full-text articles were excluded because they do not have the outcome of interest (severe COVID-19, ICU admission, the need for mechanical ventilation, and mortality), 3 full-text articles were excluded because they do not have the control/comparison group, 1 full-text article were excluded because the articles were not in English, and finally, 21 studies 15 , 16 , 17 , 18 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 with a total of 54,276 COVID-19 patients and 4,640 patients with OSA were included in the meta-analysis ( Figure 1 ). Of a total of 21 included studies, 19 were retrospective cohort, 1 study was a prospective cohort, while the remaining 1 study was a case-control study.…”

Laboratory parameters predicting mortality of adult in-patients with COVID-19 associated cytokine release syndrome treated with high-dose tocilizumab

“…Furthermore, we might postulate that low dose tocilizumab (<8 mg/kg) may not be sufficient to provide optimal effect in patients with COVID-19 associated CRS. In a recent retrospective study, lower doses of tocilizumab administration (400 mg for 30-100 kg and 600 mg over 100 kg) was related to a rebound of CRP levels, suggesting the need for higher and/or repeated doses of tocilizumab [34].…”