Outcome of COVID-19 patients with use of Tocilizumab: A single center experience

• Published in: International immunopharmacology 2020-11, Vol.88, p.106926-106926, Article 106926
• Main Authors: Zain Mushtaq, Muhammad, Bin Zafar Mahmood, Saad, Jamil, Bushra, Aziz, Adil, Ali, Syed Ahsan
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Betacoronavirus; Biomarkers - blood; C-reactive protein; Coronavirus Infections - drug therapy; Coronavirus Infections - immunology; Coronavirus Infections - mortality; Coronaviruses; COVID-19; Critical Care - methods; Critical Illness; Critically ill; Cytokines; Dimers; Female; Ferritin; Humans; Immunosuppressive agents; Inflammation; Interleukin 6; Interleukin-6 - blood; L-Lactate dehydrogenase; Lactate dehydrogenase; Lactic acid; Male; Middle Aged; Oxygen; Pakistan; Pandemics; Parameters; Patients; Pneumonia, Viral - drug therapy; Pneumonia, Viral - immunology; Pneumonia, Viral - mortality; Respiration, Artificial; Respiratory distress syndrome; Retrospective Studies; SARS-CoV-2; Serum levels; Severity of Illness Index; Tocilizumab; Treatment; Treatment Outcome
• ISSN: 1567-5769; 1878-1705; 1878-1705
• DOI: 10.1016/j.intimp.2020.106926

•Cytokine release syndrome can lead to severe deterioration in COVID-19 patients.•No treatment has yet proven completely beneficial for COVID-19 patients.•Tocilizumab was administered to 40 severely ill COVID-19 patients.•Majority of our study patients showed improvement after Tocilizumab administration. COVID-19 pandemic has become a global concern. Cytokine release syndrome (CRS) complicates acute respiratory distress syndrome (ARDS) and causes multi-organ failure which can subsequently lead to mortality in COVID-19 patients. Tocilizumab, an interleukin-6 antagonist, has shown to salvage patients with cytokine release storm. In this study, we aim to evaluate therapeutic response of Tocilizumab in COVID-19 patients. A single-arm retrospective review of 40 patients with COVID-19, admitted to The Aga Khan University Hospital Karachi, from March 2020 to May 2020 was performed. Selection of patients for use of Tocilizumab was based on severity of disease, rapid clinical deterioration, presence of CRS and absence of any absolute contraindication to Tocilizumab. Improvement after Tocilizumab was defined as improvement in oxygen requirement and inflammatory parameters. Serum levels of inflammatory cytokines like C-reactive protein, ferritin, D-dimer and lactate dehydrogenase levels were monitored before and after administering Tocilizumab. Mean age was 62.4 years and 33 (82.5%) were male. 19 (47.5%) patients were critically sick, 18 (45%) were severely sick and 3 (7.5%) were moderately sick. 29 (77.5%) patients showed significant improvement in oxygen requirement, inflammatory parameters and chest x-rays, out of which 28 patients were discharged home. The mean duration between administration of Tocilizumab and overall improvement was 4.3 ± 3.2 days. Hence, Tocilizumab can be used as a possible treatment option in patients with COVID-19 induced CRS but needs monitoring for its adverse effects.