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Late onset infectious complications and safety of tocilizumab in the management of COVID-19.
J Med Virol. 2021 03; 93(3):1459-1464.JM

Abstract

BACKGROUND

Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug-related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID-19 patients.

METHODS

All adult inpatients with COVID-19 between 1 March and 25 April 2020 that received TCZ were included. We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions.

RESULTS

Seventy-four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (P = .013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, P = .03).

CONCLUSION

Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use.

Authors+Show Affiliations

Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois.Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois.Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois.Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois.Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois.Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois.Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32790075

Citation

Pettit, Natasha N., et al. "Late Onset Infectious Complications and Safety of Tocilizumab in the Management of COVID-19." Journal of Medical Virology, vol. 93, no. 3, 2021, pp. 1459-1464.
Pettit NN, Nguyen CT, Mutlu GM, et al. Late onset infectious complications and safety of tocilizumab in the management of COVID-19. J Med Virol. 2021;93(3):1459-1464.
Pettit, N. N., Nguyen, C. T., Mutlu, G. M., Wu, D., Kimmig, L., Pitrak, D., & Pursell, K. (2021). Late onset infectious complications and safety of tocilizumab in the management of COVID-19. Journal of Medical Virology, 93(3), 1459-1464. https://doi.org/10.1002/jmv.26429
Pettit NN, et al. Late Onset Infectious Complications and Safety of Tocilizumab in the Management of COVID-19. J Med Virol. 2021;93(3):1459-1464. PubMed PMID: 32790075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late onset infectious complications and safety of tocilizumab in the management of COVID-19. AU - Pettit,Natasha N, AU - Nguyen,Cynthia T, AU - Mutlu,Gökhan M, AU - Wu,David, AU - Kimmig,Lucas, AU - Pitrak,David, AU - Pursell,Kenneth, Y1 - 2020/08/21/ PY - 2020/06/30/received PY - 2020/08/10/accepted PY - 2020/8/14/pubmed PY - 2021/3/11/medline PY - 2020/8/14/entrez KW - Il-6 inhibition KW - SARS coronavirus KW - coronavirus KW - cytokine/chemokine KW - immune responses KW - tocilizumab SP - 1459 EP - 1464 JF - Journal of medical virology JO - J Med Virol VL - 93 IS - 3 N2 - BACKGROUND: Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug-related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID-19 patients. METHODS: All adult inpatients with COVID-19 between 1 March and 25 April 2020 that received TCZ were included. We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions. RESULTS: Seventy-four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (P = .013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, P = .03). CONCLUSION: Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32790075/Late_onset_infectious_complications_and_safety_of_tocilizumab_in_the_management_of_COVID_19_ L2 - https://doi.org/10.1002/jmv.26429 DB - PRIME DP - Unbound Medicine ER -