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Tocilizumab in patients with COVID-19: which patient, time, and dose?
J Anesth. 2021 Jul 15 [Online ahead of print]JA

Abstract

Tocilizumab (TCZ) is a recombinant anti-interleukin-6 monoclonal antibody which showed uprising evidence as an anti-inflammatory agent which modulates the cytokine storm in patients with COVID-19. However, proper use of the drug requires selection of the appropriate patient and timing. The two main factors which might improve patient selection are the degree of respiratory failure and systemic inflammation. TCZ can decrease the mortality and progression to invasive mechanical ventilation in patients with severe COVID-19 who are not yet invasively ventilated. However, its use in invasively ventilated patients did not yet gain the same level of evidence especially when administered after > 1 day from mechanical ventilation. Being an anti-inflammatory and immunomodulatory drug, TCZ was mostly used in patients with COVID-19 who have clear signs of cytokine storm. However, the drug still showed positive response in some studies which did not strictly select patients with elevated markers of systemic inflammation. Thus, it is warranted to investigate and/or re-analyze the role of the drug in patients with severe COVID-19 and with no signs of systemic inflammation. TCZ is used in a dose of 8 mg/kg which can be repeated if there was no clinical improvement. However, there are no clear criteria for judgment of the success of the first dose. Being a drug with a major effect on gross outcomes in a serious pandemic with millions of mortalities, TCZ should be meticulously investigated to reach definitive indications and number of doses to avoid drug overuse, shortage, and side effects.

Authors+Show Affiliations

Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, Egypt. ahmedmohamedhasanin@gmail.com.Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 elsarayah street, Elmanyal, Cairo, Egypt.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34264384

Citation

Hasanin, Ahmed, and Maha Mostafa. "Tocilizumab in Patients With COVID-19: Which Patient, Time, and Dose?" Journal of Anesthesia, 2021.
Hasanin A, Mostafa M. Tocilizumab in patients with COVID-19: which patient, time, and dose? J Anesth. 2021.
Hasanin, A., & Mostafa, M. (2021). Tocilizumab in patients with COVID-19: which patient, time, and dose? Journal of Anesthesia. https://doi.org/10.1007/s00540-021-02974-0
Hasanin A, Mostafa M. Tocilizumab in Patients With COVID-19: Which Patient, Time, and Dose. J Anesth. 2021 Jul 15; PubMed PMID: 34264384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab in patients with COVID-19: which patient, time, and dose? AU - Hasanin,Ahmed, AU - Mostafa,Maha, Y1 - 2021/07/15/ PY - 2021/06/02/received PY - 2021/07/10/accepted PY - 2021/7/15/entrez PY - 2021/7/16/pubmed PY - 2021/7/16/medline KW - COVID-19 KW - SARS-CoV-2 KW - Tocilizumab JF - Journal of anesthesia JO - J Anesth N2 - Tocilizumab (TCZ) is a recombinant anti-interleukin-6 monoclonal antibody which showed uprising evidence as an anti-inflammatory agent which modulates the cytokine storm in patients with COVID-19. However, proper use of the drug requires selection of the appropriate patient and timing. The two main factors which might improve patient selection are the degree of respiratory failure and systemic inflammation. TCZ can decrease the mortality and progression to invasive mechanical ventilation in patients with severe COVID-19 who are not yet invasively ventilated. However, its use in invasively ventilated patients did not yet gain the same level of evidence especially when administered after > 1 day from mechanical ventilation. Being an anti-inflammatory and immunomodulatory drug, TCZ was mostly used in patients with COVID-19 who have clear signs of cytokine storm. However, the drug still showed positive response in some studies which did not strictly select patients with elevated markers of systemic inflammation. Thus, it is warranted to investigate and/or re-analyze the role of the drug in patients with severe COVID-19 and with no signs of systemic inflammation. TCZ is used in a dose of 8 mg/kg which can be repeated if there was no clinical improvement. However, there are no clear criteria for judgment of the success of the first dose. Being a drug with a major effect on gross outcomes in a serious pandemic with millions of mortalities, TCZ should be meticulously investigated to reach definitive indications and number of doses to avoid drug overuse, shortage, and side effects. SN - 1438-8359 UR - https://www.unboundmedicine.com/medline/citation/34264384/Tocilizumab_in_patients_with_COVID-19:_which_patient,_time,_and_dose L2 - https://dx.doi.org/10.1007/s00540-021-02974-0 DB - PRIME DP - Unbound Medicine ER -
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