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Impact of Tocilizumab on Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: A Single-Center Experience.
J Pharm Pract. 2021 Jul 07 [Online ahead of print]JP

Abstract

BACKGROUND

Tocilizumab is an interleukin-6 receptor antagonist hypothesized to blunt the uncontrolled immune response, cytokine release syndrome, in severe COVID-19 and prevent attributable morbidity and mortality. Objective: The objective of this study was to assess the impact of tocilizumab on clinical outcomes in COVID-19-associated cytokine release syndrome.

METHODS

Single-center, retrospective cohort study assessing sixty-nine adult patients receiving tocilizumab for suspected COVID-19 cytokine release syndrome. The primary outcome was change in WHO clinical status scale on day seven post-dose analyzed using the Wilcoxon signed rank test. Secondary outcomes assessed impact of timing of administration on clinical outcome. Safety analyses included development of neutropenia, thrombocytopenia, transaminitis, and sepsis within 7 days post-dose. Statistical analyses were conducted using Microsoft Excel.

RESULTS

No aggregate clinical change was found between day 0 and day 7. Eleven patients improved, twenty-seven worsened, and thirty-one showed no change. Clinical outcomes were weakly correlated with time from symptom onset (rs = 0.21; p = 0.08) or hospital admission (rs = -0.08; p = 0.49) to dose. In-hospital mortality was 63%. Sepsis was diagnosed in 21 patients, five of which were post-dose. Transaminitis, neutropenia, and thrombocytopenia occurred in seven, one, and six patients, respectively.

CONCLUSION

Tocilizumab did not appear to influence clinical outcomes in our study population, irrespective of timing of administration. Adverse events were not considered drug-related.

Authors+Show Affiliations

Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Medicine, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Medicine, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.Department of Medicine, Clara Maass Medical Center, Belleville, NJ, USA.Department of Pharmacy, Clara Maass Medical Center, Belleville, NJ, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34231415

Citation

Raja, Karan, et al. "Impact of Tocilizumab On Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: a Single-Center Experience." Journal of Pharmacy Practice, 2021, p. 8971900211028208.
Raja K, Daniel N, Morrison S, et al. Impact of Tocilizumab on Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: A Single-Center Experience. J Pharm Pract. 2021.
Raja, K., Daniel, N., Morrison, S., Patel, R., Gerges, J., Nadeem, K., Chen, B., Kang, S., Patel, M., Beggs, D., Attalla, M., Ballem, N., & Philips, M. (2021). Impact of Tocilizumab on Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: A Single-Center Experience. Journal of Pharmacy Practice, 8971900211028208. https://doi.org/10.1177/08971900211028208
Raja K, et al. Impact of Tocilizumab On Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: a Single-Center Experience. J Pharm Pract. 2021 Jul 7;8971900211028208. PubMed PMID: 34231415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Tocilizumab on Clinical Outcomes in COVID-19-Associated Cytokine Release Syndrome: A Single-Center Experience. AU - Raja,Karan, AU - Daniel,Nicole, AU - Morrison,Susan, AU - Patel,Ruben, AU - Gerges,Jessica, AU - Nadeem,Komal, AU - Chen,Brandon, AU - Kang,Soo, AU - Patel,Mitesh, AU - Beggs,Donald, AU - Attalla,Mark, AU - Ballem,Naveen, AU - Philips,Mona, Y1 - 2021/07/07/ PY - 2021/7/7/entrez PY - 2021/7/8/pubmed PY - 2021/7/8/medline KW - COVID-19 KW - cytokine release syndrome KW - cytokine storm KW - interleukin-6 receptor antagonist KW - tocilizumab SP - 8971900211028208 EP - 8971900211028208 JF - Journal of pharmacy practice JO - J Pharm Pract N2 - BACKGROUND: Tocilizumab is an interleukin-6 receptor antagonist hypothesized to blunt the uncontrolled immune response, cytokine release syndrome, in severe COVID-19 and prevent attributable morbidity and mortality. Objective: The objective of this study was to assess the impact of tocilizumab on clinical outcomes in COVID-19-associated cytokine release syndrome. METHODS: Single-center, retrospective cohort study assessing sixty-nine adult patients receiving tocilizumab for suspected COVID-19 cytokine release syndrome. The primary outcome was change in WHO clinical status scale on day seven post-dose analyzed using the Wilcoxon signed rank test. Secondary outcomes assessed impact of timing of administration on clinical outcome. Safety analyses included development of neutropenia, thrombocytopenia, transaminitis, and sepsis within 7 days post-dose. Statistical analyses were conducted using Microsoft Excel. RESULTS: No aggregate clinical change was found between day 0 and day 7. Eleven patients improved, twenty-seven worsened, and thirty-one showed no change. Clinical outcomes were weakly correlated with time from symptom onset (rs = 0.21; p = 0.08) or hospital admission (rs = -0.08; p = 0.49) to dose. In-hospital mortality was 63%. Sepsis was diagnosed in 21 patients, five of which were post-dose. Transaminitis, neutropenia, and thrombocytopenia occurred in seven, one, and six patients, respectively. CONCLUSION: Tocilizumab did not appear to influence clinical outcomes in our study population, irrespective of timing of administration. Adverse events were not considered drug-related. SN - 1531-1937 UR - https://www.unboundmedicine.com/medline/citation/34231415/Impact_of_Tocilizumab_on_Clinical_Outcomes_in_COVID-19-Associated_Cytokine_Release_Syndrome:_A_Single-Center_Experience. L2 - https://journals.sagepub.com/doi/10.1177/08971900211028208?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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