Effects of Tocilizumab in COVID-19 patients: a cohort study.

Academic Article

Abstract

  • BACKGROUND: Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2. METHODS: A retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020. RESULTS: Most patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1-21) after initial symptoms and 2 days (range 0-12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO2/FiO2 and an initial reduction in CRP, but this effect was not sustained beyond day 10. CONCLUSIONS: Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.
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    Keywords

  • COVID-19, Coronavirus, Cytokine release syndrome, Tocilizumab, Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Humanized, COVID-19, Cohort Studies, Female, Hospitalization, Humans, Male, Middle Aged, Receptors, Interleukin-6, Respiratory Insufficiency, Retrospective Studies, SARS-CoV-2, Treatment Outcome
  • Digital Object Identifier (doi)

    Author List

  • Vu CA; DeRonde KJ; Vega AD; Maxam M; Holt G; Natori Y; Zamora JG; Salazar V; Boatwright R; Morris SR
  • Start Page

  • 964
  • Volume

  • 20
  • Issue

  • 1