Effects of tocilizumab versus hemoadsorption combined with tocilizumab in patients with SARS-CoV-2 pneumonia: Preliminary results

• Published in: International journal of artificial organs 2022-01, Vol.45 (1), p.75-80
• Main Authors: Berlot, Giorgio, Pintacuda, Stefania, Moro, Edoardo, Paluzzano, Giacomo, Scamperle, Alice, Chillemi, Antonino, Longo, Irene, Dattola, Roberto, Roman-Pognuz, Erik, Tomasini, Ariella
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Humanized; C-reactive protein; COVID-19 - drug therapy; Cytokines; Humans; Inflammation; Interleukin 6; Mechanical ventilation; Patients; Pneumonia; Retrospective Studies; SARS-CoV-2; Scavenging; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Ventilation
• ISSN: 0391-3988; 1724-6040
• DOI: 10.1177/0391398821989334

Objective: To assess the variations of Interleukin-6 (IL-6) in patients with SARS-CoV-2 infection treated with Tocilizumab (TCZ) alone or in association with hemoadsorption (HA). Design: Retrospective. Setting: An Intensive Care Unit (ICU) admitting mechanically ventilated patients with SARS-CoV-2 pneumonia. Patients: Four adult patients. Interventions: We compared the blood values of IL-6, C-reactive protein (CRP) and of other biochemical variables including the PaO2/FiO2 in two patients who received TCZ alone and in other 2 in whom it was associated with the HA (TCZ-HA) due to the presence of impending or established organ failures other than the lung. All variables were measured before, during and after the treatment. Main results: In all patients, the IL-6 increased during the treatment; after its termination, its values sharply decreased only in those treated also with HA; conversely, the CRP decreased in all patients; the PaO2/FiO2 increased in three patients and remained stable in the remaining one. Both the TCZ and the HA were well tolerated; all patients were weaned from the mechanical ventilation and discharged from the hospital. Limitations: Although the limited number of patients does not allow to draw firm conclusions, the increase of the IL-6 of can be ascribed to its displacement from cellular and soluble receptors, whereas its decrease is likely due to the scavenging effect exerted by the HA. Although the association TCZ-HA could be valuable in the treatment of the Cytokine Release Storm (CRS) associated with the SARS-CoV-2, the HA could be more effective as it neutralizes a wider panel of inflammatory mediators.