Appropriate use of Tocilizumab in COVID-19 Infection

Link to article at PubMed

Int J Infect Dis. 2020 Jul 26:S1201-9712(20)30580-4. doi: 10.1016/j.ijid.2020.07.036. Online ahead of print.


OBJECTIVE: We aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory, and radiologic observations.

METHODS: All the patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, complete blood count, and procalcitonin. Computerized thoracic tomography was obtained on admission, when oxygen support was necessary, and seven days after TCZ start. Disease course of the patients was grouped as severe or critical according to their clinical, laboratory, and radiologic evaluations.

RESULTS: In total, 43 patients were included; 70% of the patients was male; the median age was 64 (min-max: 27-94), 6 (14%) patients were fatal. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs 4 days, p < 0.001). Only 3 cases out of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones.

CONCLUSION: Earlier use of TCZ in COVID-19 infection is beneficial for survival, length of hospitalization, and duration of oxygen support. Our recommendation for the administration of TCZ is based on the increase in requirement of the oxygen support, progression in the thorax computerized tomography, and elevation of inflammation markers, including IL-6, CRP, ferritin, and D-dimer and decrease in percent of lymphocyte.

PMID:32726724 | DOI:10.1016/j.ijid.2020.07.036

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