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The effect of tocilizumab on cytokine release syndrome in COVID-19 patients.
Pharmacol Rep. 2020 Dec; 72(6):1529-1537.PR

Abstract

BACKGROUND

This study was aimed to assess the efficacy and safety of tocilizumab (TCZ) and to investigate the factors related to the progress and mortality of patients with a secondary cytokine release syndrome caused by SARS-CoV-2.

METHODS

A retrospective descriptive observational study of hospitalised patients with a positive polymerase chain reaction (PCR) result for SARS-CoV-2 and whose clinical evolution required the administration of one or more doses of TCZ was conducted. Demographic variables, clinical evolution, radiologic progress and analytical parameters were analysed on days 1, 3 and 5 after administration the first dose of TCZ.

RESULTS

A total of 75 patients with a clinical history of Accurate Respiratory Distress Syndrome (ARDS) were analysed, among whom, 19 had mild ARDS (25.3%), 37 moderate ARDS (49.4%) and 19 severe ARDS (25.3%). Lymphocytopenia and high levels of PCR, D-Dimer and IL-6 were observed in almost all the patients (91.8%). Treatment with TCZ was associated with a reduction of lymphocytopenia, C-reactive protein (CRP) levels, severe ARDS cases and fever. Although a better evolution of PaO2/FiO2 was observed in patients who received two or more doses of TCZ (38/75), there was an increase in their mortality (47.4%) and ICU admission (86.8%). The 30-day mortality rate was 30.7% (20.5-42.4% CI) being hypertension, high initial D-dimer levels and ICU admission the only predictive factors found.

CONCLUSION

Based on our results, treatment with TCZ was associated with a fever, swelling and ventilator support improvement. However, there is no evidence that the administration of two or more doses of TCZ was related to a mortality decrease.

Authors+Show Affiliations

Pharmacy Department, Hospital General de Segovia, C/Luis Erik Clavería Neurólogo S/N, 40002, Segovia, Spain. carmendcv@hotmail.com.Internal Medicine Department, Hospital General de Segovia, C/Luis Erik Clavería Neurólogo S/N, 40002, Segovia, Spain.Internal Medicine Department, Hospital General de Segovia, C/Luis Erik Clavería Neurólogo S/N, 40002, Segovia, Spain.Pharmacy Department, Hospital General de Segovia, C/Luis Erik Clavería Neurólogo S/N, 40002, Segovia, Spain.Análisis Estadísticos 3Datos SL, Salamanca, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33165762

Citation

de Cáceres, Carmen, et al. "The Effect of Tocilizumab On Cytokine Release Syndrome in COVID-19 Patients." Pharmacological Reports : PR, vol. 72, no. 6, 2020, pp. 1529-1537.
de Cáceres C, Martínez R, Bachiller P, et al. The effect of tocilizumab on cytokine release syndrome in COVID-19 patients. Pharmacol Rep. 2020;72(6):1529-1537.
de Cáceres, C., Martínez, R., Bachiller, P., Marín, L., & García, J. M. (2020). The effect of tocilizumab on cytokine release syndrome in COVID-19 patients. Pharmacological Reports : PR, 72(6), 1529-1537. https://doi.org/10.1007/s43440-020-00186-z
de Cáceres C, et al. The Effect of Tocilizumab On Cytokine Release Syndrome in COVID-19 Patients. Pharmacol Rep. 2020;72(6):1529-1537. PubMed PMID: 33165762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of tocilizumab on cytokine release syndrome in COVID-19 patients. AU - de Cáceres,Carmen, AU - Martínez,Rodrigo, AU - Bachiller,Pablo, AU - Marín,Laura, AU - García,José Manuel, Y1 - 2020/11/09/ PY - 2020/08/28/received PY - 2020/10/26/accepted PY - 2020/10/15/revised PY - 2020/11/10/pubmed PY - 2020/12/15/medline PY - 2020/11/9/entrez KW - Cytokine release syndrome KW - IL-6 KW - SARS-CoV-2 KW - Tocilizumab SP - 1529 EP - 1537 JF - Pharmacological reports : PR JO - Pharmacol Rep VL - 72 IS - 6 N2 - BACKGROUND: This study was aimed to assess the efficacy and safety of tocilizumab (TCZ) and to investigate the factors related to the progress and mortality of patients with a secondary cytokine release syndrome caused by SARS-CoV-2. METHODS: A retrospective descriptive observational study of hospitalised patients with a positive polymerase chain reaction (PCR) result for SARS-CoV-2 and whose clinical evolution required the administration of one or more doses of TCZ was conducted. Demographic variables, clinical evolution, radiologic progress and analytical parameters were analysed on days 1, 3 and 5 after administration the first dose of TCZ. RESULTS: A total of 75 patients with a clinical history of Accurate Respiratory Distress Syndrome (ARDS) were analysed, among whom, 19 had mild ARDS (25.3%), 37 moderate ARDS (49.4%) and 19 severe ARDS (25.3%). Lymphocytopenia and high levels of PCR, D-Dimer and IL-6 were observed in almost all the patients (91.8%). Treatment with TCZ was associated with a reduction of lymphocytopenia, C-reactive protein (CRP) levels, severe ARDS cases and fever. Although a better evolution of PaO2/FiO2 was observed in patients who received two or more doses of TCZ (38/75), there was an increase in their mortality (47.4%) and ICU admission (86.8%). The 30-day mortality rate was 30.7% (20.5-42.4% CI) being hypertension, high initial D-dimer levels and ICU admission the only predictive factors found. CONCLUSION: Based on our results, treatment with TCZ was associated with a fever, swelling and ventilator support improvement. However, there is no evidence that the administration of two or more doses of TCZ was related to a mortality decrease. SN - 1734-1140 UR - https://www.unboundmedicine.com/medline/citation/33165762/The_effect_of_tocilizumab_on_cytokine_release_syndrome_in_COVID_19_patients_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33165762/ DB - PRIME DP - Unbound Medicine ER -