Smith College

Tocilizumab inhibits Interleukin-6 (IL-6) which may mitigate the extreme inflammatory response among COVID-19 patients. 

- Outcomes among 100 severe COVID-19 patients in Brescia, Italy during 10-day follow-up after Tocilizumab infusion

- Figure illustrating how Tocilizumab calms the inflammatory storm by blocking IL-6 receptors

- Severe COVID-19 cases and the impact of tocilizumab

- Toxicities of TCZ

- Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study

- Case Report of Tocilizumab for COVID-19 Pneumonia in a Non Small Cell Lung Cancer Patient Treated with Chemo-Immunotherapy

- Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state

Tocilizumab (TCZ) As a Treatment for COVID-19

Fu, B., Xu, X., & Wei, H. (2020). Why tocilizumab could be an effective treatment for severe COVID-19?. Journal of translational medicine, 18(1), 1-5.

https://doi.org/10.1186/s12967-020-02339-3

https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-020-02339-3

Why tocilizumab could be an effective
treatment for severe COVID-19?

- 24–72 h after TCZ administration
- 10 days after TCZ administration
- Patient characteristics
- Laboratory findings
- Methods
- Discussion

Outcomes among 100 severe COVID-19 patients in Brescia, Italy during 10-day follow-up after Tocilizumab (TCZ) infusion

Figure illustrating how Tocilizumab calms the inflammatory storm by blocking IL-6 receptors

- Patients with severe cases of COVID-19 were given tocilizumab
- Tocilizumab lowered the patients’ body temperature, this returning the fever to normal (after 1 day)
- 15/20 patients required less oxygen therapy (after 5 days)
- The lymphocyte count (in peripheral blood) in about half the patients returned to the normal range
- Lowered C-reactive protein to a safe level in 16/19 patients
- All the patients were discharged after approximately 15 days


Severe COVID-19 cases and the impact of tocilizumab

- Common toxicities of TCZ include nasopharyngitis, headaches, hypertension, increased levels of aspartate aminotransferase, infusion related reactions and an increase in upper respiratory tract infections 
- Major toxicities of TCZ include hematologic effects, hepatotoxicity, gastrointestinal perforations, and hypersensitivity reactions 

Toxicities of TCZ

A retrospective observational study at 13 hospitals in New Jersey was conducted to compare the clinical outcomes in individuals infected with COVID-19 who received tocilizumab (TCZ) to infected individuals who did not receive TCZ.  Hospital-related mortality was the primary endpoint established for the study.  All 630 patients included in the study required support from the intensive care unit (ICU).  420 patients did not receive TCZ and 210 patients did receive TCZ.  

49% of the patients who received TCZ died and 61% of patients who did not receive TCZ died.  A multivariable Cox regression analysis was conducted which revealed an association between getting TCZ and lower hospital-related mortality.  Patients who needed support from a ventilator and patients who were under the age of 65 showed an especially favorable decrease in hospital-related mortality upon receiving TCZ.  Additionally, patients with concentrations of 15 mg/dL or above of C-reactive protein who received TCZ also especially exhibited a favorable decrease in hospital-related mortality.  

Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study

This case report was conducted on a 65 year old man with stage IV lung adenocarcinoma being treated with chemo-immunotherapy who developed COVID-19 pneumonia.  The patient was hospitalized and received therapy and additional oxygen support, but his clinical conditions did not get better.  However, upon administering two doses of tocilizumab to the patient, an immediate improvement in clinical conditions was observed.  The patient's level of C reactive protein decreased significantly from 212 mg/dl to 37 mg/dl, his ratio of arterial oxygen partial pressure to fractional inspired oxygen improved, and additional required oxygen supplementation decreased gradually.  There were no acute side effects that occurred.  The patient was eventually discharged.
 

Case Report of Tocilizumab for COVID-19 Pneumonia in a Non Small Cell Lung Cancer Patient Treated with Chemo-Immunotherapy

A cohort study of 778 patients with COVID-19 in a hyperinflammatory state was conducted to investigate the effect of treatment with tocilizumab and corticosteroids on intubation and death.  The patients were categorized into the following exposure groups: tocilizumab treatment, treatment with pulse dose of corticosteroids (PDC), treatment with intermediate-high dose of corticosteroids (IHDC), combination therapy of both corticosteroids and tocilizumab, and no treatment.
- 11.4% of 88 patients treated with tocilizumab were either intubated or died.  

- 23.1% of 117 patients who received IHDC were either intubated or died.  

- 15.4% of 78 patients who received PDC were either intubated or died.  
- 25.6% of 151 patients who received combination therapy were either intubated or died.  

- 21.1% of 344 patients who did not receive treatment were either intubated or died.

- Treatment with tocilizumab alone was associated with a reduced hazard of death and intubation.  

- Treatment with PDC appeared to be associated with a reduced risk of death, but the results were not consistent.  

- No significant association was detected between IHDC treatment or combination therapy and death/intubation.  

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