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Subcutaneous tocilizumab treatment in patients with severe COVID-19-related cytokine release syndrome: An observational cohort study.
Mastroianni, Antonio; Greco, Sonia; Apuzzo, Giovanni; De Santis, Salvatore; Oriolo, Carmela; Zanolini, Alfredo; Chidichimo, Luciana; Vangeli, Valeria.
  • Mastroianni A; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
  • Greco S; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
  • Apuzzo G; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
  • De Santis S; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
  • Oriolo C; Hospital Pharmacy, Annunziata Hospital, Cosenza, Italy.
  • Zanolini A; Radiology Unit, Annunziata Hospital, Cosenza, Italy.
  • Chidichimo L; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
  • Vangeli V; Infectious Diseases Unit, Annunziata Hospital, Viale della Repubblica s.n.c., 87100 Cosenza, Italy.
EClinicalMedicine ; 24: 100410, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-628334
ABSTRACT

BACKGROUND:

Patients with severe coronavirus disease 2019 (COVID-19) have elevated levels of acute phase reactants and inflammatory cytokines, including interleukin-6, indicative of cytokine release syndrome (CRS). The interleukin-6 receptor inhibitor tocilizumab is used for the treatment of chimeric antigen receptor T-cell therapy-induced CRS.

METHODS:

Patients aged 18 years or older with laboratory-confirmed COVID-19 admitted to the Annunziata Hospital in Cosenza, Italy, through March 7, 2020, who received at least one dose of tocilizumab 162 mg subcutaneously for the treatment of COVID-19-related CRS in addition to standard care were included in this retrospective observational study. The primary observation was the incidence of grade 4 CRS after tocilizumab treatment. Chest computed tomography (CT) scans were evaluated to investigate lung manifestations.

FINDINGS:

Twelve patients were included; all had fever, cough, and fatigue at presentation, and all had at least one comorbidity (hypertension, six patients; diabetes, five patients; chronic obstructive lung disease, four patients). Seven patients received high-flow nasal cannula oxygen therapy and five received non-invasive mechanical ventilation for lung complications of COVID-19. No incidence of grade 4 CRS was observed within 1 week of tocilizumab administration in all 12 patients (100%) and within 2 days of tocilizumab administration in 5 patients (42%). The predominant pattern on chest CT scans at presentation was ground-glass opacity, air bronchograms, smooth or irregular interlobular or septal thickening, and thickening of the adjacent pleura. Follow-up CT scans 7 to 10 days after tocilizumab treatment showed improvement of lung manifestations in all patients. No adverse events or new safety concerns attributable to tocilizumab were reported.

INTERPRETATION:

Tocilizumab administered subcutaneously to patients with COVID-19 and CRS is a promising treatment for reduction in disease activity and improvement in lung function. The effect of tocilizumab should be confirmed in a randomised controlled trial.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines Language: English Journal: EClinicalMedicine Year: 2020 Document Type: Article Affiliation country: J.eclinm.2020.100410

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines Language: English Journal: EClinicalMedicine Year: 2020 Document Type: Article Affiliation country: J.eclinm.2020.100410