Effects of Tocilizumab in COVID-19 patients: a cohort study
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RESEARCH ARTICLE
Open Access
Effects of Tocilizumab in COVID-19 patients: a cohort study Christine A. Vu1,2* , Kailynn J. DeRonde1, Ana D. Vega1, Meshell Maxam1, Gregory Holt3, Yoichiro Natori4, Jose Gonzales Zamora4, Veronica Salazar1, Renata Boatwright1, Stephen R. Morris4, Daniela de Lima Corvino4, Anmary Fernandez Betances4, Leah Colucci5, James Keegan5, Andy Lopez5, Andrew Hany Rezk5, Yvette Rodriguez5, Gabriela M. Moraru6, Susanne Doblecki4, David J. De La Zerda3 and Lilian M. Abbo4
Abstract Background: Due to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2. Methods: A retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020. Results: Most patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1–21) after initial symptoms and 2 days (range 0–12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO2/FiO2 and an initial reduction in CRP, but this effect was not sustained beyond day 10. Conclusions: Majority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this. Keywords: Coronavirus, COVID-19, Tocilizumab, Cytokine release syndrome
* Correspondence: [email protected] 1 Department of Pharmacy, Jackson Health System, Miami, FL, USA 2 Jackson Memorial Hospital, Pharmacy Services, B069, 1611 NW 12th Ave, Miami, FL 33136, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the mat
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