Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy

Toniati, Paola; Piva, Simone; Cattalini, Marco; Garrafa, Emirena; Regola, Francesca; Castelli, Francesco; Franceschini, Franco; Airò, Paolo; Bazzani, Chiara; Beindorf, Eva-Andrea; Berlendis, Marialma; Bezzi, Michela; Bossini, Nicola; Castellano, Maurizio; Cattaneo, Sergio; Cavazzana, Ilaria; Contessi, Giovanni-Battista; Crippa, Massimo P.; Delbarba, Andrea; Peri, E. De; Faletti, Angela; Filippini, Matteo; Frassi, Micol; Gaggiotti, Mario; Gorla, Roberto; Lanspa, Michael J.; Lorenzotti, Silvia; Marino, Rosa; Maroldi, Roberto; Metra, Marco; Matteelli, Alberto; Modina, Denise; Moioli, Giovanni; Montani, Giovanni; Muiesan, Maria-Lorenza; Odolini, Silvia; Peli, Elena; Pesenti, Silvia; Pezzoli, Maria-Chiara; Pirola, Ilenia; Pozzi, Alessandro; Proto, Alessandro; Rasulo, Francesco-Antonio; Renisi, Giulia; Ricci, Chiara; Rizzoni, Damiano; Romanelli, Giuseppe; Rossi, Maria Teresa; Salvetti, Massimo; Scolari, Francesco; Signorini, Liana; Taglietti, Marco; Tomasoni, Gabriele; Tomasoni, Lina-Rachele; Turla, Fabio; Valsecchi, Alberto; Zani, Davide Danilo; Zuccalà, Francesco; Zunica, Fiammetta; Focà, Emanuele; Andréoli, Laura; Latronico, Nicola

doi:10.1016/j.autrev.2020.102568

Cited by 690 publications

(787 citation statements)

References 21 publications

(29 reference statements)

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“…Recently it has been associated with improved survival in patients with severe COVID-19 pneumonia with evidence of CRS. 15,16 In general tocilizumab is well tolerated but can induce neutropenia, and an increased risk of developing infections has been reported. 17,18 Furthermore, it may predispose to a delay in detecting active infection because of the masking effect of a suppressed C reactive protein (CRP) response.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

Zoumot

Bonilla

Wahla

et al. 2020

Preprint

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Background: Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution.Methods: We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation.Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of patients who developed COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, two are recovering in hospital and four have been discharged home. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

Zoumot

Bonilla

Wahla

et al. 2020

Preprint

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“…Data were unavailable for mortality in 3 studies, and a pooled all-cause death rate of 16% (95% CI, 11-22%; I 2 = 67%, P< 0.0001) was reported in 870 patients when treated with tocilizumab. 17 studies 10,11,19,[21][22][23][25][26][27][28][29]31,33,[35][36][37]40 comprising 562 patients were de ned as severe COVID-19 infection, and the pooled ORR of treatment with tocilizumab was 78% (95% CI, 70-85%; I 2 = 65%, P< 0.0001), while pooled ORR in 64 nonsevere infection was 93% (95% CI, 85-98%; I 2 = 0%, P=0.66) ( Figure S2).…”

Section: Impact Of Tocilizumab Treatment On Orr and Mortality Of Covimentioning

confidence: 99%

“…At the point of study completion, median LOH and LOI was 14 days (range 11-34) and 8 days (range [5][6][7][8][9][10][11] in patients receiving tocilizumab, which was speci ed in 15 studies 10,[20][21][22][23]28,29,31,32,35,36,[38][39][40][41] and 8 studies 10,23,27,29,32,33,36,42 , separately. Moreover, the median duration of mechanical ventilation was 7 days (range 5-10) after treatment of tocilizumab which was documented in 9 articles 10,11,[21][22][23]27,28,40,41 ( Table 2).…”

Section: Impact Of Tocilizumab Treatment On Duration Of Hospitalizatimentioning

confidence: 99%

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Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

Liu

Zong

et al. 2020

Preprint

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The therapeutic effect of tocilizumab remains controversial. We aimed to evaluate whether tocilizumab might be beneficial in COVID-19 patients. We searched PubMed, Embase and Cochrane library from inception to June 23, 2020. Summary estimates of overall response rate (ORR) and all-cause death rate in all patients were analyzed. This study was registered with PROSPERO (CRD42020191313). We included data from 28 articles including 991 COVID-19 patients who underwent tocilizumab administration. The pooled ORR was 72% (95% CI, 66-79%) and pooled all-cause death rate was 16% (95% CI, 11-22%). The optimal timing of administration was the 7.15 day from the symptom onset and with the lowest death rate of 13.11%. 562 patients were defined as with severe infection, and the pooled ORR was 78% (95% CI, 70-85%). The pooled ORR of 56 organ transplantation recipients was 53% (95% CI, 26-78%), which was lower than non-transplant patients [75% (95% CI, 69-81%)]. Nearly all studies confirmed the safety of tocilizumab administration. Tocilizumab improves the clinical outcome of COVID-19 patients, especially in severe cases, and the optimal timing of administration may provide the guidance for management. However, tocilizumab may be used with caution in solid transplant recipients for the suboptimal efficacy.

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“…Immunosuppressive drugs are often used making sarcoidosis patients more vulnerable to infections. COVID-19 can be responsible for a cytokine storm syndrome for which immunosuppressive strategy could be beneficial (2,3).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical features of COVID-19 in a large cohort of 199 patients with sarcoidosis

Marques¹,

Lefevre²,

Barmo³

et al. 2020

Preprint

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Objective: To investigate the prevalence, clinical features and outcomes of coronavirus disease 2019 (COVID-19) among sarcoidosis patients. Methods: We retrospectively collected features of COVID-19 in a cohort of patients with sarcoidosis followed in a single tertiary university hospital. Results: Among 199 sarcoidosis patients [mean age 58.8 (±14) years, 86 (43.2%) men], 26 (13%) were diagnosed with COVID-19 [definite (n=7), probable (n=12) and possible (n=7)]. Twenty-four out of 26 patients (92%) had at least one comorbidity, and 11/26 (42%) had two or more comorbidities. Demographic and clinical features of COVID-19 positive patients were similar to those of COVID-19 negative patients. The administration of hydroxychloroquine or immunosuppressant was not associated with the occurrence or the severity of COVID-19. Four out of 26 (15.4%) COVID-19 positive patients required admission to hospital and two of them died. Hospitalized patients [mean age of 61 (±11.5) years] were receiving higher doses of long term treatment with corticosteroids than non-hospitalized patients; 4/4 had pulmonary and 2/4 cardiac involvement of sarcoidosis, and all one or more comorbidity. Conclusion: The prevalence of COVID-19 in sarcoidosis is slightly higher to that of the general population. Almost half of the COVID-19 positive patients have two or more comorbidities and about 15% present a severe course.

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Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy

Cited by 690 publications

References 21 publications

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

Prevalence and clinical features of COVID-19 in a large cohort of 199 patients with sarcoidosis

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