Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls

Mert, Ali; Vahaboğlu, Haluk; Arslan, Ferhat; Batırel, Ayşe; Saraçoğlu, Kemal Tolga; Baştuğ, Aliye; Çağatay, Atahan; Irmak, İlim; Dizman, Gülçin Telli; Ertenli, İhsan; Altunal, Lütfiye Nilsun; Şengel, Buket Ertürk; Bayram, Mehmet; Omma, Ahmet; Amikishiyev, S.; Aypak, Adalet; Beş, Cemal; Bölükçü, Sibel; İçten, Sacit; Topeli, Arzu; Bektaş, Murat; Arslan, Birsen Yigit; Öztürk, Savaş; Çomoğlu, Şenol; Aydın, Selda; Küçükşahin, Orhan; İçaçan, Ozan Cemal; İnce, Burak; Aghamuradov, Sarvan; Mutlu, Murad; Şimşek, Funda; Emre, Salih; Üstün, Cemal; Ergen, Pınar; Aydın, Özlem Altuntaş; Koç, Meliha Meriç; Sevindik, Omur Gokmen; Odabaşı, Zekaver; Korten, Volkan; Bodur, Hürrem; Güner, Rahmet; Ünal, Serhat; Koçak, Mehmet; Gül, Ahmet

doi:10.1007/s00296-021-04965-6

Cited by 6 publications

(3 citation statements)

References 31 publications

(36 reference statements)

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“…Regarding IL-6 blockade with tocilizumab in COVID-19-associated MAS, the results are controversial. Some studies have reported that treatment with tocilizumab contributes to reduced mortality and favorable outcomes [144,145]. Conversely, another study noted that tocilizumab demonstrated limited efficacy for COVID-19-related MAS [146].…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Macrophage Activation Syndrome in Viral Sepsis

Papageorgiou,

Gogos,

Akinosoglou

2024

Viruses

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Macrophage activation syndrome (MAS) is a life-threatening systemic hyperinflammatory syndrome triggered by various infections, particularly viral infections, autoimmune disorders, and malignancy. The condition is characterized by an increased production of proinflammatory cytokines resulting in a cytokine storm and has been associated with poor clinical outcomes. During the COVID-19 pandemic, patients with severe manifestations developed features similar to those of MAS, although these characteristics remained well defined within the lung. Additionally, other viral infections including EBV, the herpes family of viruses, hepatitis viruses, influenza, HIV, and hemorrhagic fevers can be complicated by MAS. The diagnosis and management of the condition remain challenging due to the lack of consensus on specific guidelines, especially among the adult population. Currently, therapeutic options primarily rely on medications that are typically used to treat primary hemophagocytic lymphohistiocytosis, such as corticosteroids and etoposide. In addition, cytokine-targeted therapies present promising treatment options. The objective of this review is to discuss the emergence of MAS in the context of viral infections including, but not limited to, its occurrence in COVID-19.

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Section: Therapeutic Optionsmentioning

confidence: 99%

Macrophage Activation Syndrome in Viral Sepsis

Papageorgiou,

Gogos,

Akinosoglou

2024

Viruses

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“…Overzealous immune responses associated with MAS, may be driving COVID-19 related ARDS ( 21 ). There has been research shows that treatment of MAS, such as the use of tocilizumab and the combination of tocilizumab and steroids, significantly reduced the intubation or death of severe patients ( 31 , 32 ).…”

Section: Introductionmentioning

confidence: 99%

Advances in attractive therapeutic approach for macrophage activation syndrome in COVID-19

et al. 2023

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Nowadays, people have relaxed their vigilance against COVID-19 due to its declining infection numbers and attenuated virulence. However, COVID-19 still needs to be concern due to its emerging variants, the relaxation of restrictions as well as breakthrough infections. During the period of the COVID-19 infection, the imbalanced and hyper-responsive immune system plays a critical role in its pathogenesis. Macrophage Activation Syndrome (MAS) is a fatal complication of immune system disease, which is caused by the excessive activation and proliferation of macrophages and cytotoxic T cells (CTL). COVID-19-related hyperinflammation shares common clinical features with the above MAS symptoms, such as hypercytokinemia, hyperferritinemia, and coagulopathy. In MAS, immune exhaustion or defective anti-viral responses leads to the inadequate cytolytic capacity of CTL which contributes to prolonged interaction between CTL, APCs and macrophages. It is possible that the same process also occurred in COVID-19 patients, and further led to a cytokine storm confined to the lungs. It is associated with the poor prognosis of severe patients such as multiple organ failure and even death. The main difference of cytokine storm is that in COVID-19 pneumonia is mainly the specific damage of the lung, while in MAS is easy to develop into a systemic. The attractive therapeutic approach to prevent MAS in COVID-19 mainly includes antiviral, antibiotics, convalescent plasma (CP) therapy and hemadsorption, extensive immunosuppressive agents, and cytokine-targeted therapies. Here, we discuss the role of the therapeutic approaches mentioned above in the two diseases. And we found that the treatment effect of the same therapeutic approach is different.

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“…9 In cases of severe COVID-19 pneumonia, patients who received TCZ were shown to have better outcomes, and retrospective observational cohort studies revealed an immediate decrease in fever, decreased need for oxygen therapy and mechanical ventilation, as well as an improvement in lung symptoms. [10][11][12][13][14]…”

Section: Introductionmentioning

confidence: 99%

Tocilizumab treatment in COVID-19: A prognostic study using propensity score matching

et al. 2022

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Background. The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors. Objectives.To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care. Materials and methods.Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.Results. A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0. 157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).Conclusions. This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

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Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls

Cited by 6 publications

References 31 publications

Macrophage Activation Syndrome in Viral Sepsis

Macrophage Activation Syndrome in Viral Sepsis

Advances in attractive therapeutic approach for macrophage activation syndrome in COVID-19

Tocilizumab treatment in COVID-19: A prognostic study using propensity score matching

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