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Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: A Cautionary Case Report.
Chest. 2020 07; 158(1):e15-e19.Chest

Abstract

Novel coronavirus disease 2019 (COVID-19) emerged in late December 2019 in Wuhan, China. Since then, COVID-19 has become a pandemic affecting more than 4.1 million people worldwide. Patients with COVID-19 have a wide spectrum of manifestations, one being cytokine release syndrome (CRS) and its fatal correlate, secondary hemophagocytic lymphohistiocytosis (sHLH). Anti-cytokine therapy such as tocilizumab, an IL-6 receptor antagonist, is a potential treatment for COVID-19; however, data regarding the efficacy of this anti-IL-6 therapy are currently lacking. We report two cases of patients who received a diagnosis of COVID-19 complicated by CRS and were treated with tocilizumab. Both patients progressed to sHLH despite treatment with tocilizumab, and one developed viral myocarditis, challenging the safety and clinical usefulness of tocilizumab in the treatment of COVID-19-induced CRS. These cases highlight the need for clinical trials to determine optimal patient selection and timing for the use of tocilizumab during this disease process.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: jr1106@rwjms.rutgers.edu.Department of Pharmacy Practice and Administration, Rutgers-Ernest Mario School of Pharmacy, New Brunswick, NJ.Division of Infectious Disease, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32343968

Citation

Radbel, Jared, et al. "Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: a Cautionary Case Report." Chest, vol. 158, no. 1, 2020, pp. e15-e19.
Radbel J, Narayanan N, Bhatt PJ. Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: A Cautionary Case Report. Chest. 2020;158(1):e15-e19.
Radbel, J., Narayanan, N., & Bhatt, P. J. (2020). Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: A Cautionary Case Report. Chest, 158(1), e15-e19. https://doi.org/10.1016/j.chest.2020.04.024
Radbel J, Narayanan N, Bhatt PJ. Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: a Cautionary Case Report. Chest. 2020;158(1):e15-e19. PubMed PMID: 32343968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: A Cautionary Case Report. AU - Radbel,Jared, AU - Narayanan,Navaneeth, AU - Bhatt,Pinki J, Y1 - 2020/04/25/ PY - 2020/04/09/received PY - 2020/04/15/revised PY - 2020/04/20/accepted PY - 2020/4/29/pubmed PY - 2020/7/21/medline PY - 2020/4/29/entrez KW - COVID-19 KW - critical care KW - cytokines KW - viral disease SP - e15 EP - e19 JF - Chest JO - Chest VL - 158 IS - 1 N2 - Novel coronavirus disease 2019 (COVID-19) emerged in late December 2019 in Wuhan, China. Since then, COVID-19 has become a pandemic affecting more than 4.1 million people worldwide. Patients with COVID-19 have a wide spectrum of manifestations, one being cytokine release syndrome (CRS) and its fatal correlate, secondary hemophagocytic lymphohistiocytosis (sHLH). Anti-cytokine therapy such as tocilizumab, an IL-6 receptor antagonist, is a potential treatment for COVID-19; however, data regarding the efficacy of this anti-IL-6 therapy are currently lacking. We report two cases of patients who received a diagnosis of COVID-19 complicated by CRS and were treated with tocilizumab. Both patients progressed to sHLH despite treatment with tocilizumab, and one developed viral myocarditis, challenging the safety and clinical usefulness of tocilizumab in the treatment of COVID-19-induced CRS. These cases highlight the need for clinical trials to determine optimal patient selection and timing for the use of tocilizumab during this disease process. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/32343968/Use_of_Tocilizumab_for_COVID_19_Induced_Cytokine_Release_Syndrome:_A_Cautionary_Case_Report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(20)30764-9 DB - PRIME DP - Unbound Medicine ER -