Effects of tocilizumab versus hemoadsorption combined with tocilizumab in patients with SARS-CoV-2 pneumonia: Preliminary results

Abstract

Objective: To assess the variations of Interleukin-6 (IL-6) in patients with SARS-CoV-2 infection treated with Tocilizumab (TCZ) alone or in association with hemoadsorption (HA). Design: Retrospective. Setting: An Intensive Care Unit (ICU) admitting mechanically ventilated patients with SARS-CoV-2 pneumonia. Patients: Four adult patients. Interventions: We compared the blood values of IL-6, C-reactive protein (CRP) and of other biochemical variables including the PaO2/FiO2 in two patients who received TCZ alone and in other 2 in whom it was associated with the HA (TCZ-HA) due to the presence of impending or established organ failures other than the lung. All variables were measured before, during and after the treatment. Main results: In all patients, the IL-6 increased during the treatment; after its termination, its values sharply decreased only in those treated also with HA; conversely, the CRP decreased in all patients; the PaO2/FiO2 increased in three patients and remained stable in the remaining one. Both the TCZ and the HA were well tolerated; all patients were weaned from the mechanical ventilation and discharged from the hospital. Limitations: Although the limited number of patients does not allow to draw firm conclusions, the increase of the IL-6 of can be ascribed to its displacement from cellular and soluble receptors, whereas its decrease is likely due to the scavenging effect exerted by the HA. Although the association TCZ-HA could be valuable in the treatment of the Cytokine Release Storm (CRS) associated with the SARS-CoV-2, the HA could be more effective as it neutralizes a wider panel of inflammatory mediators.

Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series

“…18 Preliminary data in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation point toward a more pronounced reduction of IL-6 in CytoSorb-treated patients, although the initial level was much higher when compared to a control group. 19 In accord with previous reports, 20–22 we also found that IL-6 levels were effectively reduced during hemoadsorption therapy. As systemic hyperinflammation or CRS represents a complex interplay of various mediators, with a high degree of redundancy and overlap in cytokine signaling, the ability of CytoSorb to regulate a wide panel of inflammatory mediators as well as IL-6 might increase its clinical effectiveness.…”

“…As systemic hyperinflammation or CRS represents a complex interplay of various mediators, with a high degree of redundancy and overlap in cytokine signaling, the ability of CytoSorb to regulate a wide panel of inflammatory mediators as well as IL-6 might increase its clinical effectiveness. 22…”

The Use of CytoSorb Therapy in Critically Ill COVID-19 Patients: Review of the Rationale and Current Clinical Experiences

“…All five CytoSorb patients except one survived, and only two of them had to be intubated and mechanically ventilated, while all control patients required intubation and ventilation, and unfortunately died. A small retrospective analysis in four patients with SARS-CoV-2 pneumonia recently reported outcomes in two patients treated with tocilizumab (TCZ) alone and two patients treated with TCZ plus CytoSorb hemoadsorption (HA) [51]. All patients were mechanically ventilated with levels of IL-6, C-reactive protein (CRP), and PaO 2 /FiO 2 ratio measured before, during, and after treatment.…”

“…In this complex pathophysiological setting involving multiple mediators and high grade of redundancy, overlap, and/or feedback mechanisms, the broad range of action of CytoSorb therapy that targets removal of a variety of inflammatory substances in addition to cytokines could be-at least theoretically-beneficial [51].…”

Die Behandlung eines Patienten mit ausgeprägtem Zytokinsturm bei schwerer COVID-19-Pneumonie unter Einsatz von Hämoadsorption in Kombination mit der Gabe von Tocilizumab

“…Dies könnte einige der positiven Auswirkungen dieser Behandlung mit erklären [27]. Im Zusammenhang mit einem kombinierten Einsatz von Tocilizumab und CytoSorb schlussfolgert eine aktuelle Arbeit, dass das Netzwerk von Entzündungsmediatoren, das am Zytokinfreisetzungssyndrom (CRS) bei SARS-CoV-2-Patienten beteiligt ist, so kompliziert und mit so vielen positiven und negativen Rückkopplungsschleifen verbunden ist, dass die Blockade von nur einem Entzündungsmediator − wie etwa mit Tocilizumab − nicht wirksam sein könnte und daher der Einsatz von CytoSorb ratsam erscheint, da es die Entfernung vieler weiterer Entzündungsmediatoren ermöglicht [28].…”