Tocilizumab for the treatment of severe coronavirus disease 2019

Alattar, Rand A.; Ibrahim, Tawheeda; Shaar, Shahd H.; Abdalla, Shiema; Shukri, Kinda; Daghfal, Joanne; Khatib, Mohamed Y.; Aboukamar, Mohamed; Abukhattab, Mohammed; Alsoub, Hussam; Almaslamani, Muna; Omrani, Ali S.

doi:10.1002/jmv.25964

Cited by 236 publications

(285 citation statements)

References 22 publications

(50 reference statements)

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“…Meta-regression scatter plot representing the correlation between BMI and IMV is shown in Figure S2. 15,[28][29][30][31][32][33][34] No correlation was found F I G U R E 2 Odds ratios for intensive care unit admission in patients with obesity versus patients without obesity. BMI, body mass index; CI, confidence interval; ICU, intensive care unit F I G U R E 3 Odds ratios for invasive mechanical ventilation (IMV) in patients with obesity versus patients without obesity.…”

Section: Meta-regressionmentioning

confidence: 98%

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

et al. 2020

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Summary The disease course of COVID‐19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID‐19 patients by performing a meta‐analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta‐analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002‐1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16‐3.64; I2 = 34.86%) in COVID‐19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.

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Section: Meta-regressionmentioning

confidence: 98%

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

et al. 2020

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“…Early reports show that tocilizumab, an IL-6 inhibitor, may be beneficial in this patient population. [40][41][42] Furthermore, due to the observed alterations at the arterial, venous, and atrial endothelium further studies are warranted to assess the optimal anticoagulative strategy including different anticoagulants and potential combinations of anticoagulants with antiplatelet drugs.…”

Section: Novel Therapeutic Approaches In Covid-19mentioning

confidence: 99%

COVID-19-Induced Cytokine Release Syndrome Associated with Pulmonary Vein Thromboses, Atrial Cardiomyopathy, and Arterial Intima Inflammation

Goette

Patscheke

Henschke³

et al. 2020

TH Open

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Coronavirus disease 2019 (COVID-19) is a viral disease induced by severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2), which may cause an acute respiratory distress syndrome (ARDS). First reports have shown that elevated levels of inflammatory cytokines might be involved in the development of organ dysfunction in COVID-19. Here, we can present a case of cytokine release syndrome induced by SARS–CoV-2 causing multiorgan failure and death. Of note, we can report on pulmonary vein thromboses as potential source of cerebrovascular embolic events. Furthermore, we present a specific form of an isolated inflammatory atrial cardiomyopathy encompassing atrial myocardium, perivascular matrix, as well as atrial autonomic nerve ganglia, causing atrial fibrillation, sinus node arrest, as well as atrial clot formation in the right atrial appendage. An associated acute glomerulonephritis caused acute kidney failure. Furthermore, all the described pathologies of organs and vessels were associated with increased local expression of interleukin-6 and monocyte chemoattractant protein-1 (MCP-1). This report provides new evidence about fatal pathologies and summarizes the current knowledge about organ manifestations observed in COVID-19.

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“…In a single centre study from Wuhan including 15 patients TOCI appeared to be an effective treatment option in patients with cytokine storm [13]. In a retrospective analysis of 25 unmatched ICU patients, TOCI at the median dose of 5,7 mg/Kg showed a signi cant reduction in invasive mechanical ventilation at day 14, although 90% of patients showed adverse events [26]. A prospective multi-centre safety study on 66 patients reported no moderate to severe adverse events related to TOCI with a signi cant improvement in PaO2/FiO2 ratio, ferritin, C-reactive protein, D-dimer and lymphocytes count at day 14 [27].…”

Section: Discussionmentioning

confidence: 98%

Effects of Cytokine Blocking Agents on Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

Coloretti

Busani

Biagioni

et al. 2020

Preprint

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Background The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID19. Tocilizumab and Anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods The association between therapy with Tocilizumab or Anakinra and in-hospital mortality was assessed in consecutive adult COVID19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who receive to those who did not receive Tocilizumab or Anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with Tocilizumab or Anakinra and after patient matching. Results Sixty-six patients who received immunotherapy (49 Tocilizumab, 17 Anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0,77, 95% CI 0,56-1,05, p=0,069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0,35, 95% CI 0,16-0,77, p=0,009). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need of mechanical ventilation.

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Tocilizumab for the treatment of severe coronavirus disease 2019

Cited by 236 publications

References 22 publications

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

COVID-19-Induced Cytokine Release Syndrome Associated with Pulmonary Vein Thromboses, Atrial Cardiomyopathy, and Arterial Intima Inflammation

Effects of Cytokine Blocking Agents on Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

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