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Early use of tocilizumab in the prevention of adult respiratory failure in SARS-CoV-2 infections and the utilization of interleukin-6 levels in the management.
J Med Virol. 2020 Jul 09 [Online ahead of print]JM

Abstract

Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin-6 (IL-6) trends and MV in patients with SARS-CoV-2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. TCZ was administered followed by methylprednisolone to patients with >3L oxygen requirement and pneumonia severity index score ≤130 with computed tomography scan changes. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D-dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤0.05. Eighty out of 112 SARS-CoV-2-positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL-6 levels pre-administration of TCZ was 342.50 (78.25-666.25) pg/mL compared with post-administration on day 3 (563; 162-783) pg/mL (P < .00001). On day 6, the median dropped to 545 (333.50-678.50) pg/mL compared with day 3 (P = .709). CRP, ferritin, LDH, and D-dimer levels were reduced after TCZ therapy. Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL-6 levels may be helpful as a prognostic tool.

Authors+Show Affiliations

Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.Department of Medicine, Mountain View Regional Medical Center, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.Department of Clinical Pharmacy, The Hospitals of Providence Transmountain Campus, El Paso, Texas.Department of Pulmonary and Critical Care, Las Palmas Del Sol Healthcare, El Paso, Texas.Department of Medicine, Las Palmas Del Sol Healthcare, El Paso, Texas.Department of Medicine, Las Palmas Del Sol Healthcare, El Paso, Texas.Department of Medicine, Las Palmas Del Sol Healthcare, El Paso, Texas.Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32644254

Citation

Antony, Suresh J., et al. "Early Use of Tocilizumab in the Prevention of Adult Respiratory Failure in SARS-CoV-2 Infections and the Utilization of Interleukin-6 Levels in the Management." Journal of Medical Virology, 2020.
Antony SJ, Davis MA, Davis MG, et al. Early use of tocilizumab in the prevention of adult respiratory failure in SARS-CoV-2 infections and the utilization of interleukin-6 levels in the management. J Med Virol. 2020.
Antony, S. J., Davis, M. A., Davis, M. G., Almaghlouth, N. K., Guevara, R., Omar, F., Del Rey, F., Hassan, A., Arian, M. U., Antony, N., & Prakash, B. V. (2020). Early use of tocilizumab in the prevention of adult respiratory failure in SARS-CoV-2 infections and the utilization of interleukin-6 levels in the management. Journal of Medical Virology. https://doi.org/10.1002/jmv.26288
Antony SJ, et al. Early Use of Tocilizumab in the Prevention of Adult Respiratory Failure in SARS-CoV-2 Infections and the Utilization of Interleukin-6 Levels in the Management. J Med Virol. 2020 Jul 9; PubMed PMID: 32644254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early use of tocilizumab in the prevention of adult respiratory failure in SARS-CoV-2 infections and the utilization of interleukin-6 levels in the management. AU - Antony,Suresh J, AU - Davis,Michelle A, AU - Davis,Monique G, AU - Almaghlouth,Nouf K, AU - Guevara,Roberto, AU - Omar,Fahad, AU - Del Rey,Fernando, AU - Hassan,Ali, AU - Arian,Muhammad U, AU - Antony,Nishaal, AU - Prakash,Bharat V, Y1 - 2020/07/09/ PY - 2020/06/20/received PY - 2020/07/02/revised PY - 2020/07/03/accepted PY - 2020/7/10/pubmed PY - 2020/7/10/medline PY - 2020/7/10/entrez KW - IL-6 levels KW - SARS-CoV-2 KW - early treatment KW - mechanical ventilation KW - outcomes JF - Journal of medical virology JO - J. Med. Virol. N2 - Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin-6 (IL-6) trends and MV in patients with SARS-CoV-2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. TCZ was administered followed by methylprednisolone to patients with >3L oxygen requirement and pneumonia severity index score ≤130 with computed tomography scan changes. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D-dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤0.05. Eighty out of 112 SARS-CoV-2-positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL-6 levels pre-administration of TCZ was 342.50 (78.25-666.25) pg/mL compared with post-administration on day 3 (563; 162-783) pg/mL (P < .00001). On day 6, the median dropped to 545 (333.50-678.50) pg/mL compared with day 3 (P = .709). CRP, ferritin, LDH, and D-dimer levels were reduced after TCZ therapy. Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL-6 levels may be helpful as a prognostic tool. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32644254/Early_use_of_tocilizumab_in_the_prevention_of_adult_respiratory_failure_in_SARS_CoV_2_infections_and_the_utilization_of_interleukin_6_levels_in_the_management_ L2 - https://doi.org/10.1002/jmv.26288 DB - PRIME DP - Unbound Medicine ER -
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