Tocilizumab treatment in COVID-19: A single center experience

J Med Virol. 2020 Jul;92(7):814-818. doi: 10.1002/jmv.25801. Epub 2020 Apr 15.

Abstract

Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms recently. In the present study, we aimed to discuss the treatment response of TCZ therapy in COVID-19 infected patients. The demographic, treatment, laboratory parameters of C-reactive protein (CRP) and IL-6 before and after TCZ therapy and clinical outcome in the 15 COVID-19 patients were retrospectively assessed. Totally 15 patients with COVID-19 were included in this study. Two of them were moderately ill, six were seriously ill and seven were critically ill. The TCZ was used in combination with methylprednisolone in eight patients. Five patients received the TCZ administration twice or more. Although TCZ treatment ameliorated the increased CRP in all patients rapidly, for the four critically ill patients who received an only single dose of TCZ, three of them (No. 1, 2, and 3) still dead and the CRP level in the rest one patient (No. 7) failed to return to normal range with a clinical outcome of disease aggravation. Serum IL-6 level tended to further spiked firstly and then decreased after TCZ therapy in 10 patients. A persistent and dramatic increase of IL-6 was observed in these four patients who failed treatment. TCZ appears to be an effective treatment option in COVID-19 patients with a risk of cytokine storms. And for these critically ill patients with elevated IL-6, the repeated dose of the TCZ is recommended.

Keywords: COVID-19; SARS-CoV-2; Tocilizumab; cytokine storms; interleukin-6.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Betacoronavirus / drug effects
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • China / epidemiology
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology*
  • Disease Outbreaks*
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunologic Factors / therapeutic use*
  • Interleukin-6 / blood
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology*
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Biomarkers
  • IL6 protein, human
  • Immunologic Factors
  • Interleukin-6
  • C-Reactive Protein
  • tocilizumab
  • Methylprednisolone

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2