Tocilizumab Utilization for Coronavirus Disease 2019

Abstract

Background The deterioration of patients with coronavirus disease 2019 (COVID-19) has been hypothesized to be due to cytokine release syndrome including interleukin-6 (IL-6). Tocilizumab (TCZ) is an IL-6 inhibitor that may be a potential therapy for COVID-19. Methods Patients hospitalized for COVID-19 and treated with TCZ between March 1, 2020, and March 26, 2020, at an academic medical center in New York City were described. Patients were categorized as severe illness or critical illness based on previously described definitions. Outcomes assessed included respiratory status improvement, laboratory values, discharge, or death. Results A total of 12 patients were included in this case series. Ten patients were classified as critical and 2 as severe. Eight (n = 6 critical and n = 2 severe) patients had improvements in respiratory symptoms after receiving TCZ and were discharged, but 4 patients expired despite receiving therapy. All patients had an elevation in IL-6 and C-reactive protein levels before TCZ treatment. After TCZ treatment, there was a significant decrease in C-reactive protein levels (P = 0.002) and an increase in aspartate aminotransferase (P = 0.18) and alanine aminotransferase (P = 0.006) levels. Patients who received TCZ treatment later in their hospitalization course had a poor outcome. Conclusions Tocilizumab may play a role in treating patients with COVID-19 with elevated IL-6 levels, who are classified as severely ill and treated early in their disease course. The risks of adverse events and economic burdens should also be evaluated.