Repurposed Tocilizumab in Patients with Severe COVID-19.

Abstract

The coronavirus disease 2019 (COVID-19) has caused a global pandemic, resulting in considerable morbidity and mortality. Tocilizumab, an inhibitor of IL-6, has been widely repurposed as a treatment of severely ill patients without robust evidence supporting its use. In this study, we aimed to systematically describe the effectiveness of treatment and prevention of the cytokine storms in COVID-19 patients with tocilizumab. In this multicentered retrospective and observational cohort study, 65 patients with COVID-19 receiving tocilizumab and 130 not receiving tocilizumab were propensity score matched at a ratio of 2:1 based on age, sex, and comorbidities from January 20, 2020 to March 18, 2020 in Wuhan, China. After adjusting for confounding, the detected risk for in-hospital death was lower in the tocilizumab group versus nontocilizumab group (hazard ratio = 0.47; 95% confidence interval = 0.25-0.90; p = 0.023). Moreover, use of tocilizumab was associated with a lower risk of acute respiratory distress syndrome (odds ratio = 0.23; 95% confidence interval = 0.11-0.45; p < 0.0001). Furthermore, patients had heightened inflammation and more dysregulated immune cells before treatment, which might aggravate disease progression. After tocilizumab administration, abnormally elevated IL-6, C-reactive protein, fibrinogen, and activated partial thromboplastin time decreased. Tocilizumab may be of value in prolonging survival in patients with severe COVID-19, which provided a novel strategy for COVID-19-induced cytokine release syndrome. Our findings could inform bedside decisions until data from randomized, controlled clinical trials become available.

• Authors: Jianbo Tian, Ming Zhang, Meng Jin, Fengqin Zhang, Qian Chu, Xiaoyang Wang, Can Chen, Huihui Yue, Li Zhang, Ronghui Du, Dong Zhao, Zhaofu Zeng, Yang Zhao, Kui Liu, Mengmei Wang, Ke Hu, Xiaoping Miao, Huilan Zhang
• Journal: Journal of immunology (Baltimore, Md. : 1950) (J Immunol) Vol. 206 Issue 3 Pg. 599-606 (02 01 2021) ISSN: 1550-6606 [Electronic] United States
• PMID: 33298617 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2021 by The American Association of Immunologists, Inc.

Chemical References

• Antibodies, Monoclonal, Humanized
• Interleukin-6
• tocilizumab

Topics

• Aged
• Antibodies, Monoclonal, Humanized (therapeutic use)
• COVID-19 (complications, immunology)
• Cohort Studies
• Cytokine Release Syndrome (complications, drug therapy, immunology)
• Drug Repositioning
• Female
• Humans
• Interleukin-6 (immunology)
• Male
• Middle Aged
• Respiratory Distress Syndrome (complications, drug therapy, immunology)
• Retrospective Studies
• SARS-CoV-2
• Severity of Illness Index
• COVID-19 Drug Treatment