ABSTRACT Aim: Tocilizumab (TCZ) has become a prominent antibody-based therapeutic option among treatment regimens during the Corona Virus 2019 (COVID-19) pandemic. This study aimed to evaluate laboratory changes, prognostic laboratory biomarkers, and the effects of the timing of TCZ application on mortality in COVID-19 patients who underwent TCZ.
Methods: This retrospective, sectional study was conducted with COVID-19 patients received additional TCZ-based treatment. TCZ was administered at a dose of 8 mg/kg/day. The patients' data were recruited from their follow-up records and the digital hospital information system.
Results: The data of 64 patients have been subjected to evaluation. The mean age of all patients was 62.43 ± 14.2. Half of the patients who placed in the intensive care unit had received invasive respiratory support. All patients had received favipiravir, hydroxychloroquine, and convalescent plasma-based therapy. The mean time of TCZ administration was 7 days after hospitalization. In general, ferritin and d-dimer levels stood out as prognostic biomarkers among the laboratory results, whereas in lymphopenic patients, the acute-phase reactants were favored. The presence of comorbidities was associated with an increase in hospital stay and mortality. Mortality was found to increase in patients who received early administration of TCZ.
Conclusion: Prognostic biomarkers previously addressed were also prominent in our study. Considering that early TCZ administration is deemed risky in the literature and may increase mortality, caution should be exercised in its early application.
Cite this Article As : Akay Cizmecioglu H, Goktepe MH, Bayraktar HI, Cizmecioglu A. Interplay of Tocilizumab in Critical COVID-19 Cases. Mev Med Sci. 2023;3(2):66-71
Conflict of interest : The authors declare that they have no conflict of interest.
Mevlana Tıp Bilimleri 2023, Vol3, Issue2 E-ISSN: 2757-976X
Received : , Accepted : , Published Online :
References
1. Bartoli A, Gabrielli F, Alicandro T, et al. COVID-19 treatment options: a difficult journey between failed attempts and experimental drugs. Intern Emerg Med 2021;16(2):281-308.
2. COVID-19 treatment guidelines. https://www.covid19treatmentguidelines.nih.gov/therapies. Accessed on January 23th, 2023
3. Sheppard M, Laskou F, Stapleton PP, et al. Tocilizumab (ActeTCZ). Hum Vaccin Immunother 2017;13(9):1972-88.
4. Sebba A. Tocilizumab: the first interleukin-6-receptor inhibitor. Am J Health Syst Pharm 2008;65(15):1413-8.
5. Mima T, Nishimoto N. Clinical value of blocking IL-6 receptor. Curr Opin Rheumatol 2009;21(3):224-30.
6. Barbalho SM, Prado Neto EV, De Alvares Goulart R, et al. Myokines: a descriptive review. J Sports Med Phys Fitness 2020;60(12):1583-90.
7. Nara H, Watanabe R. Anti-Inflammatory Effect of Muscle-Derived Interleukin-6 and Its Involvement in Lipid Metabolism. Int J Mol Sci 2021;22(18).
8. Copaescu A, Smibert O, Gibson A, et al. The role of IL-6 and other mediators in the cytokine storm associated with SARS-CoV-2 infection. J Allergy Clin Immunol 2020;146(3):518-34 e1.
9. Potere N, Batticciotto A, Vecchie A, et al. The role of IL-6 and IL-6 blockade in COVID-19. Expert Rev Clin Immunol 2021;17(6):601-18.
10. Elahi R, Karami P, Heidary AH, et al. An updated overview of recent advances, challenges, and clinical considerations of IL-6 signaling blockade in severe coronavirus disease 2019 (COVID-19). Int Immunopharmacol 2022;105:108536.
11. Wei Q, Lin H, Wei RG, et al. Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis. Infect Dis Poverty 2021;10(1):71.
12. COVID-19 treatment guidelines. https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum. Accessed on February 2nd, 2023.
13. Tjendra Y, Al Mana AF, Espejo AP, et al. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med 2020;144(12):1465-74.
14. Crisafulli S, Isgro V, La Corte L, et al. Potential Role of Anti-interleukin (IL)-6 Drugs in the Treatment of COVID-19: Rationale, Clinical Evidence and Risks. BioDrugs 2020;34(4):415-22.
15. Covid-19 update: Tocilizumab (ActeTCZ) FDA-approved for treatment of COVID-19. Med Lett Drugs Ther 2023;65(1667):e9.
16. Saki A, Rajaei E, Rahim F. Safety and efficacy of tocilizumab for rheumatoid arthritis: a systematic review and meta-analysis of clinical trial studies. Reumatologia 2021;59(3):169-79.
17. Ozer MR, Avci A, Baloglu I, et al. Factors Associated with Intensive Care Hospitalization in Patients with Covid-19. Selcuk Med J 2022;38(2): 76-81.
18. Karki R, Sharma BR, Tuladhar S, et al. Synergism of TNF-alpha and IFN-gamma Triggers Inflammatory Cell Death, Tissue Damage, and Mortality in SARS-CoV-2 Infection and Cytokine Shock Syndromes. Cell 2021;184(1):149-68 e17.
19. Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol 2014;6(10):a016295.
20. Murakami M, Hirano T. The pathological and physiological roles of IL-6 amplifier activation. Int J Biol Sci 2012;8(9):1267-80.
21. Emery P, Keystone E, Tony HP, et al. IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 2008;67(11):1516-23.
22. Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of Tocilizumab in Patients Hospitalized with Covid-19. N Engl J Med 2020;383(24):2333-44.
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KeywordsCOVID-19, Disease severity, Interleukin-6, Mortality, Tocilizumab