Rational Use of Tocilizumab in the Treatment of Novel Coronavirus Pneumonia
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LEADING ARTICLE
Rational Use of Tocilizumab in the Treatment of Novel Coronavirus Pneumonia Shengyu Zhang1 · Lei Li2 · Aizong Shen1 · Yongwu Chen1 · Zhigang Qi3
© Springer Nature Switzerland AG 2020
Abstract Since December 2019, a novel coronavirus pneumonia (COVID-19) has broken out in Wuhan, China and spread rapidly. Recent studies have found that ⁓ 15.7% of patients develop severe pneumonia, and cytokine storm is an important factor leading to rapid disease progression. Currently, there are no specific drugs for COVID-19 and the cytokine storm it causes. IL-6 is one of the key cytokines involved in infection-induced cytokine storm. Tocilizumab, which is the IL-6 receptor antagonist, has been approved by the US FDA for the treatment of cytokine release syndrome (CRS), is expected to treat cytokine storm caused by COVID-19 and is now in clinical trials. In this paper, we will elaborate the role of cytokine storm in COVID-19, the mechanism of tocilizumab on cytokine storm and the key points of pharmaceutical care based on the actual clinical application for COVID-19 in our hospital, the latest research reports, clinical trial progress of tocilizumab, drug instruction from the US FDA, and “Diagnosis and Treatment Plan of Novel Coronavirus Pneumonia (seventh trial edition)” in China, so as to provide reference for the treatment of COVID-19.
Key Points Cytokine storm is an important factor in the rapid deterioration of patients with COVID-19. Tocilizumab, an IL-6 receptor antagonist, is expected to be used in the treatment of cytokine storm caused by COVID-19 and is recommended as an immunotherapy drug for critical COVID-19 patients in China. Tocilizumab should be used cautiously in patients with serious infections, neutropenia, thrombocytopenia, and liver damage.
* Zhigang Qi [email protected] 1
Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui, China
2
Infection Department, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui, China
3
Department of Pharmacy, Wuxi People’s Hospital Attached to Nanjing Medical University, Wuxi 214023, Jiangsu, China
1 Introduction In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, and has spread rapidly in many countries. The team of Nanshan Zhong found that 87.9% patients had fever after hospitalization and in 15.7% patients this developed to severe pneumonia [1]. When COVID-19 progresses from severe to critical, patients may develop severe cytokine storm, secondary acute respiratory distress syndrome, followed by shock, tissue perfusion disorders, and even multi-organ failure [2]. Cytokine storm is an important factor in the rapid progression of COVID-19. Therefore, the treatment of cytokine storm is an important part of rescuing severe patients. Currently, there is no specific drug for SARS-CoV-2 and cytokine storm induced by
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