ABSTRACT
Background: The severity of respiratory failure in SARS-CoV-2 infection appears to be related to cytokine release syndrome (CRS), resulting in mechanical ventilation (MV). In this observational study, we investigated tocilizumab's role in the treatment of SARS-CoV-2 and the use of interleukin-6 (IL-6) levels in the management of these patients. Method(s): Patients with positive SARS-CoV-2 PCR were prospectively observed from February 1, 2020 to May 31, 2020. Data on demographics, medical history, and clinical outcomes were collected. Tocilizumab (TCZ) 4 mg/kg/day q12h was given for 24 hours, followed by methylprednisolone 60 mg q8h for 72 hours to patients with oxygen requirement of 3 L and above. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimers were monitored on days: 0, 3, and 6 following the initiation of therapy. Statistical analyses were performed using a Wilcoxon signed-rank test with significance (alpha) less than or equal to 0.05 (P <= 0.05). Result(s): A total of eighty patients (45 males, 56.96%) and (34 females, 43.04%) with positive SARS-CoV-2 PCR were included in this study. The median age was 63 (51 - 72) years. Seven patients expired (8.75%), and nine patients required mechanical ventilation (11.25%). The median of IL-6 levels before administration of TCZ was 342.50 (78.25 - 666.25) pg/mL compared to after administration of TCZ on day 3, 563 (162-783) pg/mL (P < 0.00001). On day 6, the median dropped to 545 (333.50 - 678.50) pg/mL as compared to day 3 (P = 0.709). Moreover, CRP, ferritin, LDH, and D-dimers levels were reduced following the administration of TCZ. TABLE 1: IL-6 of SARS-CoV-2 patients at before and after Tocilizumab Treatment Conclusion(s): Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels, which may be useful inflammatory indices in the management of SARS-CoV-2 patients. Furthermore, the sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. The use of IL-6 levels may be helpful as a prognostic tool and in the management of acutely ill SARS-CoV-2 patients.
ABSTRACT
Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin-6 (IL-6) trends and MV in patients with SARS-CoV-2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. TCZ was administered followed by methylprednisolone to patients with >3L oxygen requirement and pneumonia severity index score ≤130 with computed tomography scan changes. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D-dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤0.05. Eighty out of 112 SARS-CoV-2-positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL-6 levels pre-administration of TCZ was 342.50 (78.25-666.25) pg/mL compared with post-administration on day 3 (563; 162-783) pg/mL (P < .00001). On day 6, the median dropped to 545 (333.50-678.50) pg/mL compared with day 3 (P = .709). CRP, ferritin, LDH, and D-dimer levels were reduced after TCZ therapy. Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL-6 levels may be helpful as a prognostic tool.