Abstract
Background. Acute respiratory distress syndrome (ARDS) in severe COVID-19 pneumonia is mostly responsible for high mortality rate. Tocilizumab, an interleukin-6 (IL-6) inhibitors, down-regulates the progression of cytokine storm leading to ARDS. Objectives. The study aimed to assess the clinical outcomes of three consecutive intravenous doses of tocilizumab in patients with severe COVID-19 pneumonia. Methods. This retrospective observational study was conducted on severe COVID-19 pneumonia patients in a single-center who were treated with three intravenous dose of tocilizumab (8 mg/Kg of body weight, max 800 mg per dose × 3) along with intravenous dexamethasone. Three doses of tocilizumab-associated changes in respiratory function, clinical outcomes and mortality rate were analyzed. Results. Seventy-four patients (N) received intravenous tocilizumab therapy. After third intravenous dose of tocilizumab (48-72 h apart from the second dose), SpO2 (blood oxygen saturation) was increased and the requirement of supplemental oxygen (RSO) was decreased more than after the second dose [Median: 96.5% (IQR: 96-98%) and Median: 0 (IQR: 0-1 L), respectively versus Median: 92% (IQR: 91-92%) and Median: 6 L (IQR: 5-7.2 L, respectively] (P <0.05). SpO2 was normalized in 78.4% of patients (P=0.001) treated with three doses of tocilizumab. Further RSO and demand of invasive mechanical ventilation support were increased in 21.6% (58/74 patients) and 14.8% (11/74 patients) of patients, respectively with a 30-day mortality rate of 4% (3/74 patients). Tocilizumab therapy was well tolerated in all patients. Conclusions. An additional third intravenous dose of tocilizumab improved clinical outcomes and reduced mortality rate in patients with severe COVID-19 pneumonia.
Highlights
A sudden pneumonia outbreak in Wuhan, China in December 2019 within a couple-of-month, through a declaration of World Health Organization (WHO) on 11 March 2020, was introduced to world population as “COVID-19 pandemic” caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and rapidly spread to more than 200 countries around the world [1]
Excessive release of proinflammatoy cytokines, including IL-2 leads to cytokine storm in host body that may results in bilateral pneumonia and acute respiratory distress syndrome (ARDS)
The number of male patients was higher than the females (54 and 20, respectively, N = 74) and the median age was 62 years (IQR: 52-68.3 years)
Summary
A sudden pneumonia outbreak in Wuhan, China in December 2019 within a couple-of-month, through a declaration of World Health Organization (WHO) on 11 March 2020, was introduced to world population as “COVID-19 (coronavirus disease-2019) pandemic” caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and rapidly spread to more than 200 countries around the world [1]. Excessive release of proinflammatoy cytokines, including IL-2 (interleukin-2) leads to cytokine storm in host body that may results in bilateral pneumonia and acute respiratory distress syndrome (ARDS). Acute respiratory distress syndrome (ARDS) in severe COVID-19 pneumonia is mostly responsible for high mortality rate. The study aimed to assess the clinical outcomes of three consecutive intravenous doses of tocilizumab in patients with severe COVID-19 pneumonia. This retrospective observational study was conducted on severe COVID-19 pneumonia patients in a single-center who were treated with three intravenous dose of tocilizumab (8 mg/Kg of body weight, max 800 mg per dose × 3) along with intravenous dexamethasone. An additional third intravenous dose of tocilizumab improved clinical outcomes and reduced mortality rate in patients with severe COVID-19 pneumonia
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