Abstract
BackgroundTocilizumab (TCZ), an interleukin-6 (IL-6) receptor blocker, emerged as a treatment for cytokine release syndrome (CRS) in patients with severe COVID-19 pneumonia. The main objective of the study is to discuss the treatment response of TCZ in severe and critically ill patients with COVID-19 pneumonia. Patient demographics, laboratory parameters before and after TCZ therapy, and clinical outcomes in 20 patients in a single center were prospectively reviewed.ResultsOut of 120 patients, 96 (80%) were males and 24 (20%) were females. Only eight (10%) patients did not have any previously known comorbidity. There were 78 (65%) patients with severe disease, while 42 (35%) have critically severe disease. Of the 120 patients, only 36 required a second dose of TCZ in our study based on clinical background. Neutrophils and C-reactive protein (CRP) levels were observed to be raised in all patients, while lymphopenia was observed in 114/120, and D-dimer levels were elevated in 102 (85%) patients. After the second dose of tocilizumab, 102 (85%) patients reduced oxygen requirement within four days, and 14 patients were removed on the second dose of tocilizumab on clinical grounds. Of these 120 patients, in two weeks, 30 (25%) were discharged. Within three weeks, 60 of them were discharged, while 12 were discharged after three weeks, and 18 patients died in our study despite treatment.ConclusionTCZ appeared to be a good treatment option in patients with CRS and severe and critical pneumonia, and for patients with raised IL-6 levels despite single TCZ therapy, a repeat dose is recommended.
Highlights
The pandemic caused by SARS-CoV-2 infection has transformed the world into a hybrid era of information, treatment, and way of living since December 2019
There were 78 (65%) patients with severe disease, while 42 (35%) have critically severe disease
Neutrophils and C-reactive protein (CRP) levels were observed to be raised in all patients, while lymphopenia was observed in 114/120, and D-dimer levels were elevated in 102 (85%) patients
Summary
The pandemic caused by SARS-CoV-2 infection has transformed the world into a hybrid era of information, treatment, and way of living since December 2019. Patients who died of this fatal infection were found to have extremely high pro-inflammatory markers (interleukin-6 (IL-6)) in their first clinical case reports. In this initial clinical-pathological process of SARS-CoV-2 infection, bilateral diffuse alveolar exudative injury with CD4 and CD8 cell reduction and an upsurge of Th17 cells on the injury site are observed [1]. Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor humanized monoclonal antibody, is recommended by the Novel Coronavirus Diagnosis and Treatment of Pneumonia guidelines by the National Health Commission of China for severely ill patients with elevated IL-6. Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor blocker, emerged as a treatment for cytokine release syndrome (CRS) in patients with severe COVID-19 pneumonia. Laboratory parameters before and after TCZ therapy, and clinical outcomes in 20 patients in a single center were prospectively reviewed
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