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Use of tocilizumab for COVID-19 infection-induced cytokine release syndrome: A cautionary case report.
Chest. 2020 Apr 25;:
Authors: Radbel J, Narayanan N, Bhatt PJ
Abstract
Novel coronavirus, COVID-19 emerged late December 2019 in Wuhan, China. Since then, COVID-19 has become a pandemic affecting more than 1.5 million people worldwide. Patients with COVID-19 have a wide spectrum of manifestations, one being cytokine release syndrome (CRS) and its fatal correlate, secondary hemophagocytic lymphohistiocytosis (sHLH). Anti-cytokine therapy such as tocilizumab, an interleukin-6 (IL-6) receptor antagonist, is a potential treatment for COVID-19, however data regarding the efficacy of this anti-IL-6 therapy is currently lacking. We report two cases of patients diagnosed with COVID-19 complicated by CRS treated with tocilizumab. Both patients progressed to sHLH despite treatment with tocilizumab and one developed viral myocarditis challenging the safety and clinical utility of tocilizumab in the treatment of COVID-19-induced CRS. These cases highlight the need for clinical trials to determine optimal patient selection and timing for the use of tocilizumab during this disease process.
PMID: 32343968 [PubMed - as supplied by publisher]