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, it has been proposed that tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure. 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. On the day of administration, the median PaO2/FiO2 was 166 (range 33–523) and 50 patients (83.3%) had ARDS. By day 30, 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. There was an increase in PaO2/FiO2 and an initial reduction in CRP that was not sustained beyond day 10. Conclusions Majority of patients demonstrated clinical improvement and were successfully discharged from the hospital alive after receiving tocilizumab. Similar to previous studies, infectious complications were not uncommon. A rebound effect with CRP was observed, 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 treatment of COVID-19, however randomized controlled studies are urgently needed.

ESCAPE: An Open-Label Trial of Personalized Immunotherapy in Critically Ill COVID-19 Patients

“…This was also found at the clinical setting of ESCAPE where the expression of HLA-DR on circulating monocytes was increased over the first four days of treatment. Interestingly, treatment with tocilizumab was accompanied by increase of serum IL-6, a finding also described by others (10). Tocilizumab is antagonizing the receptor of IL-6 and this may lead to reciprocal increase of IL-6.…”

Roles of existing drug and drug targets for COVID-19 management

“…A study conducted by Christine A. Vu et al showed that since tocilizumab administration to COVID-19 begun, the majority of patients showed clinical progress and were safely released alive from the hospital [ 13 ] On the contrary, however, a randomized trial study involving hospitalized patients with severe COVID-19 pneumonia showed the use of tocilizumab did not result in considerably better clinical status or lower mortality than placebo at 28 days course of therapy [ 14 ].…”