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Effectiveness and safety of intravenous tocilizumab to treat COVID-19-associated hyperinflammatory syndrome: Covizumab-6 observational cohort.
Clin Immunol. 2021 02; 223:108631.CI

Abstract

Although the starting event in COVID-19 is a viral infection some patients present with an over-exuberant inflammatory response, leading to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS). Since IL-6 plays a critical role in the inflammatory response, we assessed the efficacy and safety of tocilizumab (TCZ) in this single-centre, observational study in all Covid-19 in-patient with a proven SARS-CoV-2 rapidly progressing infection to prevent ALI and ARDS. 104 patients with COVID-19 treated with TCZ had a lower mortality rate (5·8%) compared with the regional mortality rate (11%), hospitalized patient's mortality (10%), and slightly lower than hospitalized patients treated with our standard of care alone (6%). We found that TCZ rapidly decreased acute phase reactants, ferritin and liver release of proteins. D-Dimer decreased slowly. We did not observe specific safety concerns. Early administration of IL6-R antagonists in COVID-19 patients with impending hyperinflammatory response, may be safe and effective treatment to prevent, ICU admission and further complications.

Authors+Show Affiliations

Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain. Electronic address: Hcorominas@santpau.cat.Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Farmacología (CIBERSAM), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Respiratori, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Farmàcia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Reumatologia, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.Servei de Farmacología (CIBERSAM), Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.Servei d'Urgències, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Servei de Medicina Interna, Barcelona, Catalonia, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Unitat de Malalties infeccioses, Barcelona, Catalonia, Spain.Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33189888

Citation

Corominas, Hèctor, et al. "Effectiveness and Safety of Intravenous Tocilizumab to Treat COVID-19-associated Hyperinflammatory Syndrome: Covizumab-6 Observational Cohort." Clinical Immunology (Orlando, Fla.), vol. 223, 2021, p. 108631.
Corominas H, Castellví I, Pomar V, et al. Effectiveness and safety of intravenous tocilizumab to treat COVID-19-associated hyperinflammatory syndrome: Covizumab-6 observational cohort. Clin Immunol. 2021;223:108631.
Corominas, H., Castellví, I., Pomar, V., Antonijoan, R., Mur, I., Matas, L., Gich, I., de Benito, N., Laiz, A., Castillo, D., Villamarin, L., Filella, D., Millán, A. M., Quijada, M. Á., Puig, M., Casademont, J., & Domingo, P. (2021). Effectiveness and safety of intravenous tocilizumab to treat COVID-19-associated hyperinflammatory syndrome: Covizumab-6 observational cohort. Clinical Immunology (Orlando, Fla.), 223, 108631. https://doi.org/10.1016/j.clim.2020.108631
Corominas H, et al. Effectiveness and Safety of Intravenous Tocilizumab to Treat COVID-19-associated Hyperinflammatory Syndrome: Covizumab-6 Observational Cohort. Clin Immunol. 2021;223:108631. PubMed PMID: 33189888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness and safety of intravenous tocilizumab to treat COVID-19-associated hyperinflammatory syndrome: Covizumab-6 observational cohort. AU - Corominas,Hèctor, AU - Castellví,Ivan, AU - Pomar,Virginia, AU - Antonijoan,Rosa, AU - Mur,Isabel, AU - Matas,Laia, AU - Gich,Ignasi, AU - de Benito,Natividad, AU - Laiz,Ana, AU - Castillo,Diego, AU - Villamarin,Laura, AU - Filella,David, AU - Millán,Ana Milena, AU - Quijada,María Ángeles, AU - Puig,Mireia, AU - Casademont,Jordi, AU - Domingo,Pere, Y1 - 2020/11/12/ PY - 2020/09/10/received PY - 2020/11/04/revised PY - 2020/11/09/accepted PY - 2020/11/16/pubmed PY - 2021/1/29/medline PY - 2020/11/15/entrez KW - COVID-19 KW - Cytokine release syndrome KW - IL-6R antagonist KW - SARS-CoV-2 KW - Tocilizumab KW - Treatment SP - 108631 EP - 108631 JF - Clinical immunology (Orlando, Fla.) JO - Clin Immunol VL - 223 N2 - Although the starting event in COVID-19 is a viral infection some patients present with an over-exuberant inflammatory response, leading to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS). Since IL-6 plays a critical role in the inflammatory response, we assessed the efficacy and safety of tocilizumab (TCZ) in this single-centre, observational study in all Covid-19 in-patient with a proven SARS-CoV-2 rapidly progressing infection to prevent ALI and ARDS. 104 patients with COVID-19 treated with TCZ had a lower mortality rate (5·8%) compared with the regional mortality rate (11%), hospitalized patient's mortality (10%), and slightly lower than hospitalized patients treated with our standard of care alone (6%). We found that TCZ rapidly decreased acute phase reactants, ferritin and liver release of proteins. D-Dimer decreased slowly. We did not observe specific safety concerns. Early administration of IL6-R antagonists in COVID-19 patients with impending hyperinflammatory response, may be safe and effective treatment to prevent, ICU admission and further complications. SN - 1521-7035 UR - https://www.unboundmedicine.com/medline/citation/33189888/Effectiveness_and_safety_of_intravenous_tocilizumab_to_treat_COVID_19_associated_hyperinflammatory_syndrome:_Covizumab_6_observational_cohort_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-6616(20)30791-9 DB - PRIME DP - Unbound Medicine ER -