Is tocilizumab effective in cytokine release syndrome in patients diagnosed with COVID-19?: a retrospective preliminary study

Abstract

Objectives: Although the prognosis is good in the vast majority of patients who are diagnosed with COVID-19, there are cases in which Acute Respiratory Distress Syndrome (ARDS) and multiple organ failure occur rapidly and result in death in a short time. It has been reported that severe clinical presentation is caused by cytokine release syndrome, and studies are currently conducted on treatments to reduce mortality in these patients. There are studies reporting the positive effects of anti-Human IL-6 Receptor Monoclonal Antibody, tocilizumab (TCZ), which specifically inhibits the functions of IL-6, in cases with cytokine storm. Data on TCZ use in intensive care are very limited.

Methods: The medical records of 20 patients diagnosed with COVID-19 who were treated with standard treatment and TCZ in the ICU were retrospectively reviewed.

Results: Twenty patients were included in the review. Nine (45%) received TCZ. The median length of stay in the ICU was 20 days in the TCZ group, and 14 days in the standard treatment group (p = 0.21). Mortality rate was 22.2% in TCZ group and 45.5% in the standard treatment group (p = 0.27).

Conclusions: At day 28, mortality rate and clinical improvement was not statistically different in patients receiving standard treatment with TCZ and patients in standard treatment group. Additional data are needed to understand the eficacy and safety of TCZ.

Keywords

• COVİD-19
• cytokine release syndrome
• tocilizumab

References

1. 1. Wu J, Yuan Z, Wang B, Gu R, Li W, Xiang X, et al. Severe acute respiratory syndrome coronavirus 2: from gene structure to pathogenic mechanisms and potential therapy. Front Microbiol 2020;11:1576.
2. 2. Hozhabri H, Sparascio FP, Sohrabi H, Mousavifar L, Roy R, Scribano D, et al. The global emergency of novel coronavirus (SARS-CoV-2): an update of the current status and forecasting. Int J Environ Res Public Health 2020;16:5648.
3. 3. Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus disease 2019–COVID-19. Clin Microbiol Rev 2020;33:e00028-20.
4. 4. Picchianti Diamanti A, Rosado MM, Pioli C, Sesti G, Laganà B. Cytokine release syndrome in COVID-19 patients, A new scenario for an old concern: the fragile balance between infections and autoimmunity. Int J Mol Sci 2020;21:3330.
5. 5. Zhanga C, Wua Z, Li JW, Zhaoa H, Wang GQ. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J of Antimicrobial Agents 2020;55:105954.
6. 6. Fu B, Xu X, Wei H. Why tocilizumab could be an efective treatment for severe COVID-19? J Transl Med 2020;18:164.
7. 7. Ulhaq ZS, Soraya GV. Interleukin-6 as a potential biomarker of COVID-19 progression. Med Mal Infect 2020;50:382-3.
8. 8. Repuclic of Turkey Ministry of Health General Directorate of Public Health Covid-19 (SARS-CoV-2) Guide. Available from:https://covid19.saglik.gov.tr/Eklenti/37702/0/covid-19rehberiantisitokin-antiinflamatuartedavilerkoagulopatiyonetimipdf.pdf Accessed 2020 June 1.

9. 9. Ortiz-Prado E, Simbaña-Rivera K, Gómez- Barreno L, Rubio-Neira M, Guaman LP, Kyriakidis NC, et al. Clinical, molecular, and epidemiological characterization of the SARS-CoV-2 virus and the coronavirus disease 2019 (COVID-19), a comprehensive literature review. Diagn Microbiol Infect Dis 2020;98:115094.
10. 10. Buckley LF, Wohlford GF, Ting C, Alahmed A, Van Tassell BW, Abbate A, et al. Role for anti-cytokine therapies in severe coronavirus disease 2019. Crit Care Explor 2020;2:e0178.
11. 11. Odabasi Z, Cinel İ. Consideration of severe coronavirus disease 2019 as viral sepsis and potential use of immune checkpoint inhibitors. Crit Care Explor 2020;2:e0141.
12. 12. Radbel J, Narayanan N, Bhatt PJ. Use of tocilizumab for COVID-19-induced cytokine release syndrome: a cautionary case report. Chest 2020;158:e15-19.
13. 13. Kewan T, Covut F, Al-Jaghbeer MJ, Rose L, Gopalakrishna KV, Akbik B. Tocilizumab for treatment of patients with severe COVID-19: a retrospective cohort study. EClinicalMedicine 2020;24:100418.
14. 14. Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: a single center experience. J Med Virol 2020;92:814-8.
15. 15. De Rossia N, Scarpazzab C, Filippinia C, Cordiolia C, Rasiaa S, Mancinellia CR. Early use of low dose tocilizumab in patients with COVID-19: a retrospective cohort study with a complete follow-up. EClinicalMedicine 2020;25:100459.
16. 16. Fu B, Xu X, Wei H. Why tocilizumab could be an efective treatment for severe COVID-19? J Transl Med 2020;18:164.
17. 17. Campochiaroa C, Della-Torrea E, Cavallia G, De Lucaa G, Ripa M, Boffini N, et al. Efficacy and safety of tocilizumab in severe COVID-19 patients: a single centre retrospective cohort study. Eur J Intern Med 2020;76:43-9.
18. 18. Colaneri M, Bogliolo L, Valsecchi P, Sacchi P, Zuccaro V, Brandolino F, et al. Tocilizumab for treatment of severe COVID-19 patients: preliminary results from SMAtteo COvid19 REgistry (SMACORE). Microorganisms 2020;8:695.