Abstract
The COVID-19 disease is an unprecedented international public health emergency and considerably impacts the global economy and health service system. While awaiting the development of an effective vaccine, searching for the therapy for severe or critical COVID-19 patients is essential for reducing the mortality and alleviating the tension of the health service system. Cytokine release syndrome (CRS) induced by elevated interleukin-6 was recognized to underscore the pathology of severe COVID-19 patients. Inhibiting CRS by agents suppressing IL-6 may relieve symptoms, shorten the hospital stay and reduce the need for oxygen therapy. Although evidence from randomized, double-blinded clinical trials is still lacking, the IL-6R inhibitor tocilizumab (TCZ) has shown some clinical benefits in the treatment of severe COVID-19 patients and have been included in clinical guidelines. In this review, we focused on the possible mechanisms of TCZ in the treatment of CRS and highlighted some significant considerations in the use of TCZ to treat COVID-19 patients.
Highlights
The novel zoonotic coronavirus disease, caused by severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2), has rapidly transmitted across the continents in the past several months and eventually evolved into a pandemic, which infected over 5,000,000 patients worldwide and resulted in over 300,000 deaths (WHO)
While the majority of the patients infected by SARS-Cov-2 only developed a mild to modest symptoms and may recover in several days, up to 20% patients demonstrated severe pneumonia and fever, which develop into acute respiratory distress syndrome (ARDS) and need admission into the intensive care unit [3]
Given the efficacy and safety of TCZ in cytokine release syndrome” (CRS) and the pivotal role of CRS in COVID-19, this review focused mainly on the existing evidence concerning the mechanisms of TCZ, and to clarify the considerations in clinical application
Summary
The novel zoonotic coronavirus disease, caused by severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2), has rapidly transmitted across the continents in the past several months and eventually evolved into a pandemic, which infected over 5,000,000 patients worldwide and resulted in over 300,000 deaths (WHO). A 1.2-, 1.5-, and 2.2-fold increase was found in mild/moderate, severe, or critical cases compared with on admission, respectively [8] These studies indicated the central role of IL-6 in the CRS and the exacerbation of COVID-19 patients, highlighting the possibility of targeting the IL-6 pathway in the treatment of patients with COVID-19. >1,000 ng/ml; D-dimer × 10 likelihood of survival normal values; LDH × 2 the upper limits a) Consecutive patients with respiratory failure and without mechanical ventilation b) respiratory rate ≥30 breaths/min; c) peripheral capillary SaO2 ≤93% or PaO2/FiO2
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