Tocilizumab challenge: A series of cytokine storm therapy experiences in hospitalized COVID‐19 pneumonia patients

Abstract

To recognize the period of exaggerated cytokine response in patients with coronavirus disease 2019 (COVID-19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. The data of 12 adult COVID-19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings, and computed tomography of the thorax imaging results were evaluated. A dramatic laboratory and clinical improvement was observed in 83% (10 out of 12) of patients after tocilizumab. In 17% (2 out of 12) of our patients, short-term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with good health. Although arterial oxygen saturations (87.58 ± 3.12%) dropped in room air in the pretocilizumab period, post-tocilizumab they normalized in all patients (94.42 ± 1%). None of them had fever after tocilizumab treatment and the levels of C-reactive protein (13.08 ± 12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10 ± 17.06), but increased significantly post-tocilizumab (155.33 ± 192.69). There is currently no proven treatment for COVID-19 induced by novel coronavirus SARS-CoV-2. Based on our experience with twelve adult COVID-19 pneumonia patients, we can say that tocilizumab, an IL-6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery.

The efficacy of IL-6 inhibitor Tocilizumab in reducing severe COVID-19 mortality: a systematic review

“…The 18 uncontrolled trial ( Table S3 ) encompassed 886 total patients who received TCZ. The mortality rate from severe COVID-19 ranged from 0% to 42.4% (SD 9.87%), although the two studies with 0% had relatively small sample sizes (20 for Xu, Han & Li (2020) and 12 for Borku Uysal et al (2020) ). The raw overall mortality rate from the 12 studies is 16.0%.…”

Use of Tocilizumab in COVID-19: A Systematic Review and Meta-Analysis of Current Evidence

“…A total of 1,246 articles were identified initially from the literature search, 1,231 from database searches and 15 from other sources such as references of relevant studies. Finally, 13 retrospective observational studies were found, amongst which seven were comparative [10][11][12][13][14][15][16] and six were single-arm [17][18][19][20][21][22]. In this meta-analysis, only seven comparative studies were included.…”

“…The baseline characteristics and outcomes of six single-arm, observational studies investigating the safety of tocilizumab therapy in COVID-19 patients are shown in Table 7 [17][18][19][20][21][22]. All studies show a significantly lower all-cause mortality than that seen in other critically ill COVID-19 cohorts.…”

Cytokine Storm in COVID-19: “When You Come Out of the Storm, You Won’t Be the Same Person Who Walked in”

“…This study suggested that Tocilizumab (administered at the right time) is valuable in inhibiting the injury caused by aberrant cytokine response and offers clinical and radiological recovery. Indeed, upon use of Tocilizumab, all patients showed normalized arterial oxygen saturation levels and the eosinophil values increased significantly in response to the treatment ( 94 ). Furthermore, Tocilizumab impedes the IL-6-mediated signal transduction by blocking the IL-6 receptor interaction.…”