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VOLUME 25 , ISSUE 3 ( March, 2021 ) > List of Articles

ORIGINAL RESEARCH

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients

Sudhir Bhandari, Govind Rankawat, Ajeet Singh

Keywords : COVID-19, Cytokine storm, Interleukin-6, Tocilizumab

Citation Information : Bhandari S, Rankawat G, Singh A. Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients. Indian J Crit Care Med 2021; 25 (3):260-266.

DOI: 10.5005/jp-journals-10071-23747

License: CC BY-NC 4.0

Published Online: 20-03-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Tocilizumab (TCZ), a monoclonal antibody against the most prevalent cytokine interleukin-6 (IL-6), is an emerging therapeutic option for COVID-19 infections. The present study was undertaken to assess the therapeutic response of TCZ therapy in severely or critically ill COVID-19 patients and its role as an effective modality of management. Methods: The present retrospective observational study included 30 admitted severely or critically ill COVID-19 patients, treated with TCZ therapy on behalf of raised IL-6 levels. The patients’ data concerning medical history, clinical manifestation, arterial blood gas analysis, mode of oxygenation, radiological imaging, and outcome were extracted from their medical records and compared pre- and post-TCZ infusion. Results: All patients of the study group had symptomatic presentations with a mean PaO2/FiO2 (P/F) ratio of 205.41 before TCZ infusion. All patients had a raised IL-6 level (mean value 206.56 pg/mL) that was extremely elevated in 90% of patients. Infusion of TCZ dramatically reduced mean body temperature (100.78–99.32°F) and the requirement for supplemental oxygen (68–48%) and improved mean SpO2 (86–89%) and mean P/F ratio (208–240) within 24 hours. Three patients on noninvasive ventilation were weaned off after TCZ infusion. Serum levels of IL-6 were raised initially but declined within 3–5 days of post-TCZ infusion. Conclusion: TCZ appears to be an effective therapeutic option in severely or critically ill COVID-19 patients with raised IL-6 levels. TCZ immediately improves the clinical status of patients by a probable mechanism of inhibition of cytokine storm and reduces COVID-19-related mortalities.


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  1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507–513. DOI: 10.1016/S0140-6736(20)30211-7.
  2. Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264–266. DOI: 10.1016/j.ijid.2020.01.009. PMC 7128332. PMID 31953166.
  3. Murthy S, Gomersall CD, Fowler RA. Care for critically ill patients with COVID19. JAMA 2020;323(15):1499–1500. DOI: 10.1001/jama.2020. 3633.
  4. Lan J, Ge JW, Yu JF, Shan SS, Zhou H, Fan SL, et al. Crystal structure of the 2019-nCoV spike receptor-binding domain bound with the ACE2 receptor. 2020. Available from: https://www.biorxiv.org/content/10.1101/2020.02.19.956235v1. DOI: 10.1101/2020.02.19. 956235.
  5. Davies R, Choy E. Clinical experience of IL-6 blockade in rheumatic diseases–implications on IL-6 biology and disease pathogenesis. Semin Immunol 2014;26(1):97–104. DOI: 10.1016/j.smim.2013.12.002.
  6. Wolf J, Rose-John S, Garbers C. Interleukin-6 and its receptors: a highly regulated and dynamic system. Cytokine 2014;70(1):11–20. DOI: 10.1016/j.cyto.2014.05.024.
  7. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest 2011;121(9):3375–3383. DOI: 10.1172/JCI57158.
  8. Kaly L, Rosner I. Tocilizumab—a novel therapy for non-organ-specific autoimmune diseases. Best Pract Res Clin Rheumatol 2012;26(1):157–165. DOI: 10.1016/j.berh.2012.01.001.
  9. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623. DOI: 10.1016/j.tmaid.2020.101623.
  10. Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: a single center experience. J Med Virol 2020;92(7):814–818. DOI: 10.1002/jmv.25801.
  11. Chen X, Zhao B, Qu Y, Chen Y, Xiong J, Feng Y, et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis 2020:ciaa449. Available from: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa449/5821311 by guest on 01 June 2020. DOI: 10.1093/cid/ciaa449.
  12. Kotch C, Barrett D, Teachey DT. Tocilizumab for the treatment of chimeric antigen receptor T cell-induced cytokine release syndrome. Expert Rev Clin Immunol 2019;15(8):813–822. DOI: 10.1080/1744666X.2019.1629904.
  13. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents 2020;55(5):105954. DOI: 10.1016/j.ijantimicag.2020.105954.
  14. Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A 2020;117(20):10970–10975. DOI: 10.1073/pnas.2005615117.
  15. Nishimoto N, Terao K, Mima T, Nakahara H, Takagi N, Kakehi T. Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood 2008;112(10):3959–3964. DOI: 10.1182/blood-2008-05-155846.
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