Treatment Outcomes of Tocilizumab in Critically-Ill COVID-19 Patients, Single-Centre Retrospective Study

Wael Hafez,Arun Arya,Muneir Gador,Mohamed Ali,Mahmoud Abdelshakor,Pragati Agrawal,Ahmed Abdelrahman,Husam Saleh,Ikram Abdelli,Subrata Gupta,Osman Fadl Alla,Sara Ali,Ziad Al Baha,Honeymol Sebastian,Mohamad Azzam Ziade,Srinivasa Raghu Rao

doi:10.3390/antibiotics11020241

Wael Hafez, Arun Arya + Show 14 more

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https://doi.org/10.3390/antibiotics11020241

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Journal: Antibiotics	Publication Date: Feb 12, 2022
Citations: 4	License type: CC BY 4.0

Affiliation: National Water Research Center, Zagazig University

Abstract

(1) Background: Severe COVID-19 outcomes are associated with cytokine release syndrome, characterized by the release of several immune modulators, including Interleukin-6 (IL-6). Tocilizumab (TCZ) is an IL-6 receptor antagonist used to treat rheumatic arthritis. The study aimed to evaluate the efficacy and safety of TCZ against COVID-19. (2) Methods: This was a retrospective study including 49 severe COVID-19 patients who received TCZ therapy in NMC Royal Hospital, UAE. (3) Results: Before Tocilizumab administration, the median temperature was 37.0 (IQR 36.0–39.6), and after day seven, the median reduced to 36.5 (IQR 35.8–37.9), p > 0.001. Thirty (61.2%) patients were admitted to the ICU, of which, eight (16.3%) were on WHO scale 4, sixteen (32.6%) on scale 5, and six (20.0%) on scale 6. TCZ reduced inflammatory markers over time, including CRP, D-Dimer, Ferritin, and Fibrinogen. By the end of week seven, 14 patients died (28.6%) while 35 (71.4%) improved and were discharged. (4) Conclusions: The study showed limited improvements in COVID-19 outcomes with TCZ therapy and highlighted the importance of D-Dimer monitoring for possible risk of thrombosis. Additionally, it could be recommended to upgrade the anti-coagulation dose to therapeutic levels once TCZ therapy is decided upon.

Highlights

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that arose in Wuhan (Hubei, China) in December2019 [1]
The median age was 47.0 (IQR 16.0–89.0), male gender predominated (M/F: 41/8), and Asians made up the majority (31) of the patients (63.3%)
Before TCZ administration, 30 (61.2%) patients were admitted to the intensive care unit (ICU) and 19 (39.8%)

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that arose in Wuhan (Hubei, China) in December2019 [1]. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that arose in Wuhan (Hubei, China) in December. Clinical presentation of COVID-19 ranges from being asymptomatic to multi-organ failure and death [2]. Cytokine Release Syndrome (CRS), mediated by viral entry into host cells, is more likely the cause of disease severity, unmet treatment outcomes, and high fatality rates. It is characterized by an uncontrolled immune response, over-activated macrophages and. CRS activation is associated with several life-threatening complications involving coagulopathy and multi-organ failure [5,6]. Studies that identified COVID-19 predictors of severe illness and high mortality rates reported elevated IL-6 levels among deceased cases compared to survivors [7]

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