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Tocilizumab for the treatment of severe coronavirus disease 2019.
Alattar, Rand; Ibrahim, Tawheeda B H; Shaar, Shahd H; Abdalla, Shiema; Shukri, Kinda; Daghfal, Joanne N; Khatib, Mohamed Y; Aboukamar, Mohamed; Abukhattab, Mohamed; Alsoub, Hussam A; Almaslamani, Muna A; Omrani, Ali S.
  • Alattar R; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Ibrahim TBH; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Shaar SH; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Abdalla S; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Shukri K; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Daghfal JN; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Khatib MY; Division of Critical Care and Pulmonary Medicine, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
  • Aboukamar M; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Abukhattab M; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Alsoub HA; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
  • Almaslamani MA; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
  • Omrani AS; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
J Med Virol ; 92(10): 2042-2049, 2020 10.
Article in English | MEDLINE | ID: covidwho-306523
ABSTRACT
Tocilizumab, an interleukin-6 inhibitor, may ameliorate the inflammatory manifestations associated with severe coronavirus disease 2019 (COVID-19) and thus improve clinical outcomes. This was a retrospective review of patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow up. Twenty-five patients were included, median age was 58 years (interquartile range, 50-63) and the majority were males (92%). Co-morbidities included diabetes mellitus (48%), chronic kidney disease (16%), and cardiovascular disease (12%). Fever (92%), cough (84%), and dyspnea (72%) were the commonest presenting symptoms. All patients received at least two concomitant investigational antiviral agents. Median oral temperature was on day 1, 3, and 7 was 38.0°C, 37.3°C (P = .043), and 37.0°C (P = .064), respectively. Corresponding median C-reactive protein was 193 and 7.9 mg/L (P < .0001) and <6 mg/L (P = .0001). Radiological improvement was noted in 44% of patients by day 7% and 68% by day 14. Nine patients (36%) were discharged alive from intensive care unit and three (12%) died. The proportion of patients on invasive ventilation declined from (84%) at the time of tocilizumab initiation to 60% on day 7 (P = .031) and 28% on day 14 (P = .001). The majority (92%) of patients experienced at least one adverse event. However, it is not possible to ascertain which adverse events were directly related to tocilizumab therapy. In patients with severe COVID-19, tocilizumab was associated with dramatic decline in inflammatory markers, radiological improvement and reduced ventilatory support requirements. Given the study's limitations, the results require assessment in adequately powered randomized controlled trials.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antibodies, Monoclonal, Humanized / COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Med Virol Year: 2020 Document Type: Article Affiliation country: Jmv.25964

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antibodies, Monoclonal, Humanized / COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Med Virol Year: 2020 Document Type: Article Affiliation country: Jmv.25964