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Appropriate use of tocilizumab in COVID-19 infection.
Int J Infect Dis. 2020 Jul 26; 99:338-343.IJ

Abstract

OBJECTIVE

This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations.

METHODS

All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations.

RESULTS

Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones.

CONCLUSION

Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.

Authors+Show Affiliations

American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.American Hospital, Department of Internal Medicine, Istanbul, Turkey.Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey.American Hospital, Department of Radiology and Beykent University School of Medicine, Turkey.Koç University, College of Engineering, Department of Industrial Engineering, Istanbul, Turkey.American Hospital, Clinical Laboratory, Istanbul, Turkey.Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey.Koç University, School of Medicine, Department of Chest Diseases, Istanbul, Turkey.Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey.Koç University, School of Medicine, Department of Chest Diseases, Istanbul, Turkey.Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: oergonul@ku.edu.tr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32726724

Citation

Keske, Şiran, et al. "Appropriate Use of Tocilizumab in COVID-19 Infection." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 99, 2020, pp. 338-343.
Keske Ş, Tekin S, Sait B, et al. Appropriate use of tocilizumab in COVID-19 infection. Int J Infect Dis. 2020;99:338-343.
Keske, Ş., Tekin, S., Sait, B., İrkören, P., Kapmaz, M., Çimen, C., Uğur, S., Çelebi, İ., Bakır, V. O., Palaoğlu, E., Şentürk, E., Çağlayan, B., Çakar, N., Tabak, L., & Ergönül, Ö. (2020). Appropriate use of tocilizumab in COVID-19 infection. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 99, 338-343. https://doi.org/10.1016/j.ijid.2020.07.036
Keske Ş, et al. Appropriate Use of Tocilizumab in COVID-19 Infection. Int J Infect Dis. 2020 Jul 26;99:338-343. PubMed PMID: 32726724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appropriate use of tocilizumab in COVID-19 infection. AU - Keske,Şiran, AU - Tekin,Süda, AU - Sait,Bilgin, AU - İrkören,Pelin, AU - Kapmaz,Mahir, AU - Çimen,Cansu, AU - Uğur,Semra, AU - Çelebi,İrfan, AU - Bakır,Veli Oğuzalp, AU - Palaoğlu,Erhan, AU - Şentürk,Evren, AU - Çağlayan,Benan, AU - Çakar,Nahit, AU - Tabak,Levent, AU - Ergönül,Önder, Y1 - 2020/07/26/ PY - 2020/06/17/received PY - 2020/07/15/revised PY - 2020/07/21/accepted PY - 2020/7/30/pubmed PY - 2020/7/30/medline PY - 2020/7/30/entrez KW - COVID-19 KW - Cytokines KW - Interleukin-6 KW - Therapy KW - Tocilizumab SP - 338 EP - 343 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 99 N2 - OBJECTIVE: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. METHODS: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. RESULTS: Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. CONCLUSION: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/32726724/Appropriate_use_of_Tocilizumab_in_COVID-19_Infection L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(20)30580-4 DB - PRIME DP - Unbound Medicine ER -
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