Tocilizumab for the treatment of adult patients with severe COVID-19 pneumonia: A single-center cohort study

J Med Virol. 2021 Feb;93(2):831-842. doi: 10.1002/jmv.26308. Epub 2020 Jul 27.

Abstract

Coronavirus disease 2019 (COVID-19) can lead to a massive cytokine release. The use of the anti-interleukin-6 receptor monoclonal antibody tocilizumab (TCZ) has been proposed in this hyperinflammatory phase, although supporting evidence is limited. We retrospectively analyzed 88 consecutive patients with COVID-19 pneumonia that received at least one dose of intravenous TCZ in our institution between 16 and 27 March 2020. Clinical status from day 0 (first TCZ dose) through day 14 was assessed by a 6-point ordinal scale. The primary outcome was clinical improvement (hospital discharge and/or a decrease of ≥2 points on the 6-point scale) by day 7. Secondary outcomes included clinical improvement by day 14 and dynamics of vital signs and laboratory values. Rates of clinical improvement by days 7 and 14 were 44.3% (39/88) and 73.9% (65/88). Previous or concomitant receipt of subcutaneous interferon-β (adjusted odds ratio [aOR]: 0.23; 95% confidence interval [CI]: 0.06-0.94; P = .041) and serum lactate dehydrogenase more than 450 U/L at day 0 (aOR: 0.25; 95% CI: 0.06-0.99; P = .048) were negatively associated with clinical improvement by day 7. All-cause mortality was 6.8% (6/88). Body temperature and respiratory and cardiac rates significantly decreased by day 1 compared to day 0. Lymphocyte count and pulse oximetry oxygen saturation/FiO2 ratio increased by days 3 and 5, whereas C-reactive protein levels dropped by day 2. There were no TCZ-attributable adverse events. In this observational single-center study, TCZ appeared to be useful and safe as immunomodulatory therapy for severe COVID-19 pneumonia.

Keywords: COVID-19; SARS-CoV-2; immunomodulation; pneumonia; tocilizumab.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous
  • Adult
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antiviral Agents / therapeutic use*
  • Body Temperature / drug effects
  • C-Reactive Protein / metabolism
  • COVID-19 / drug therapy*
  • COVID-19 / immunology
  • COVID-19 / mortality
  • COVID-19 / virology
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / mortality
  • Cytokine Release Syndrome / prevention & control*
  • Cytokine Release Syndrome / virology
  • Female
  • Heart Rate / drug effects
  • Humans
  • Immunologic Factors / therapeutic use*
  • Interferon-beta / adverse effects
  • L-Lactate Dehydrogenase / blood
  • Male
  • Middle Aged
  • Receptors, Interleukin-6 / antagonists & inhibitors
  • Receptors, Interleukin-6 / genetics
  • Receptors, Interleukin-6 / immunology
  • Respiratory Rate / drug effects
  • Retrospective Studies
  • SARS-CoV-2 / immunology
  • SARS-CoV-2 / pathogenicity*
  • Severity of Illness Index
  • Survival Analysis

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Immunologic Factors
  • Receptors, Interleukin-6
  • Interferon-beta
  • C-Reactive Protein
  • L-Lactate Dehydrogenase
  • tocilizumab