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Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients: A single center experience.
Medicine (Baltimore). 2021 May 07; 100(18):e25832.M

Abstract

ABSTRACT

Tocilizumab (TCZ), a monoclonal recombinant antibody against IL-6 receptor, is currently used in managing the cytokine release syndrome (CRS) that occurred in coronavirus disease 2019 (COVID-19) selected cases. The primary objective of our study was to establish the effectiveness of TCZ in patients with severe or critical severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia.We retrospectively analyzed 25 consecutive patients, admitted in the Academic Emergency Hospital Sibiu, Romania from April 1, 2020 until May 25, 2020, all with confirmed SARS-CoV-2 infection and severe pneumonia. All patients were treated off-label with TCZ, beside their standard care. Adjuvant iron chelator was associated in 11 patients.Six female and 19 male patients admitted in our hospital all with confirmed SARS-CoV-2 infection and severe pneumonia as defined by Chinese Centers for Disease Control and Prevention were enrolled in this study. Seventeen of the 25 enrolled patients (68%) were seriously ill requiring noninvasive ventilation or oxygen mask, and 8 cases (32%) were critically ill requiring invasive mechanical ventilation. All patients received TCZ, and also received hydroxychloroquine, and lopinavir/ritonavir 200/50 mg for 10 days. Adjuvant iron chelator (deferasirox - marketed as Exjade) was associated in 11 patients who had ferritin serum levels above 1000 ng/mL. No side effects were encountered during infusions or after TCZ. We observed a rapid increase in arterial oxygen saturation for 20 of the 25 cases (80%) with a favorable evolution toward healing. Survivors were younger than 60 years old (80%), had less comorbidities (10% no comorbidities, 70% with 1 or 2 comorbidities), lower serum ferritin levels (30% under 1000 ng/mL), and 50% had no serum glucose elevation. Our patients with CRS had no response to corticosteroid therapy. Five out of the 25 patients had an unfavorable evolution to death. The off-label use of TCZ in patients with severe or critically ill form of SARS-CoV-2 infection had good results in our study.Off-label use of TCZ in severe and critical cases of COVID-19 pneumonia is effective in managing the "cytokine storm." Better outcomes were noted in younger patients. Associated adjuvant iron chelators may contribute to a good outcome and needs to be confirmed in larger studies.

Authors+Show Affiliations

Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu - Infectious Diseases Clinic, Sibiu.Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, FOISOR Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB Bucharest.Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu - Internal Medicine Clinic, Sibiu, Romania.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33950993

Citation

Birlutiu, Victoria, et al. "Off-label Tocilizumab and Adjuvant Iron Chelator Effectiveness in a Group of Severe COVID-19 Pneumonia Patients: a Single Center Experience." Medicine, vol. 100, no. 18, 2021, pp. e25832.
Birlutiu V, Birlutiu RM, Chicea L. Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients: A single center experience. Medicine (Baltimore). 2021;100(18):e25832.
Birlutiu, V., Birlutiu, R. M., & Chicea, L. (2021). Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients: A single center experience. Medicine, 100(18), e25832. https://doi.org/10.1097/MD.0000000000025832
Birlutiu V, Birlutiu RM, Chicea L. Off-label Tocilizumab and Adjuvant Iron Chelator Effectiveness in a Group of Severe COVID-19 Pneumonia Patients: a Single Center Experience. Medicine (Baltimore). 2021 May 7;100(18):e25832. PubMed PMID: 33950993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients: A single center experience. AU - Birlutiu,Victoria, AU - Birlutiu,Rares Mircea, AU - Chicea,Liana, PY - 2020/07/13/received PY - 2021/03/19/accepted PY - 2021/5/5/entrez PY - 2021/5/6/pubmed PY - 2021/5/14/medline SP - e25832 EP - e25832 JF - Medicine JO - Medicine (Baltimore) VL - 100 IS - 18 N2 - ABSTRACT: Tocilizumab (TCZ), a monoclonal recombinant antibody against IL-6 receptor, is currently used in managing the cytokine release syndrome (CRS) that occurred in coronavirus disease 2019 (COVID-19) selected cases. The primary objective of our study was to establish the effectiveness of TCZ in patients with severe or critical severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia.We retrospectively analyzed 25 consecutive patients, admitted in the Academic Emergency Hospital Sibiu, Romania from April 1, 2020 until May 25, 2020, all with confirmed SARS-CoV-2 infection and severe pneumonia. All patients were treated off-label with TCZ, beside their standard care. Adjuvant iron chelator was associated in 11 patients.Six female and 19 male patients admitted in our hospital all with confirmed SARS-CoV-2 infection and severe pneumonia as defined by Chinese Centers for Disease Control and Prevention were enrolled in this study. Seventeen of the 25 enrolled patients (68%) were seriously ill requiring noninvasive ventilation or oxygen mask, and 8 cases (32%) were critically ill requiring invasive mechanical ventilation. All patients received TCZ, and also received hydroxychloroquine, and lopinavir/ritonavir 200/50 mg for 10 days. Adjuvant iron chelator (deferasirox - marketed as Exjade) was associated in 11 patients who had ferritin serum levels above 1000 ng/mL. No side effects were encountered during infusions or after TCZ. We observed a rapid increase in arterial oxygen saturation for 20 of the 25 cases (80%) with a favorable evolution toward healing. Survivors were younger than 60 years old (80%), had less comorbidities (10% no comorbidities, 70% with 1 or 2 comorbidities), lower serum ferritin levels (30% under 1000 ng/mL), and 50% had no serum glucose elevation. Our patients with CRS had no response to corticosteroid therapy. Five out of the 25 patients had an unfavorable evolution to death. The off-label use of TCZ in patients with severe or critically ill form of SARS-CoV-2 infection had good results in our study.Off-label use of TCZ in severe and critical cases of COVID-19 pneumonia is effective in managing the "cytokine storm." Better outcomes were noted in younger patients. Associated adjuvant iron chelators may contribute to a good outcome and needs to be confirmed in larger studies. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/33950993/Off_label_tocilizumab_and_adjuvant_iron_chelator_effectiveness_in_a_group_of_severe_COVID_19_pneumonia_patients:_A_single_center_experience_ L2 - https://doi.org/10.1097/MD.0000000000025832 DB - PRIME DP - Unbound Medicine ER -