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A recent research study looks at the effect of tocilizumab on patients who need vasopressor support and invasive ventilation for COVID-19.
COVID-19 was declared a global pandemic on March 11, 2020, by the World Health Organization. Symptoms range vastly from having no symptoms at all to acute respiratory distress syndrome (ARDS), which is the leading cause of mortality.
Pro-inflammatory cytokines are a type of molecule released by immune cells that promote inflammation. Excessive production of pro-inflammatory cytokines can have a negative effect causing problems such as; low blood pressure, thrombosis, pulmonary edema, and multi-organ failure — this is known as a cytokine storm. One of the symptoms of COVID-19 particularly associated with cytokine storms is ARDS, which has accounted for a significant number of deaths. Evidence shows that these cytokine storms may be linked to poor outcomes for COVID-19 patients.
Tocilizumab is an immunosuppressive drug that is already approved for the treatment of cytokine release syndrome (CRS). Therefore, researchers identified that tocilizumab may also be beneficial in COVID-19 patients who have high levels of pro-inflammatory cytokines.
Published in EClinicalMedicine, the study analysed 51 COVID-19 patients admitted between March 13 and April 19, 2020, who were hypoxic (deprived of oxygen). In this small study, 29 patients received tocilizumab, and 23 did not. All patients received a loading dose of 400mg Hydroxychloroquine twice daily followed by 200mg twice daily for five days. 500mg Azithromycin was also given to patients for five days unless contraindicated. Patients with; hypoxia, lung infiltrates on chest X-ray, high inflammatory biomarkers, and no contraindications were given a single dose of tocilizumab.
Results from the study showed that patients who received tocilizumab had a higher rate of improvement in oxygen support. They spent less time on vasopressor support, and less time on invasive mechanical ventilation.
Vasopressors are a type of medication that raise blood pressure by tightening the blood vessels. The average duration of patients requiring vasopressor support and invasive mechanical ventilation was three days shorter for patients on tocilizumab, compared to those who did not take tocilizumab. For those patients on invasive mechanical ventilation, the amount of time to see a clinical improvement was, on average, five days shorter in the group that was given tocilizumab.
Overall, the length of hospital stay for patients on tocilizumab was longer however, this was because a higher proportion of these patients required admission to intensive care. This is only a small, retrospective study, therefore, the results require careful interpretation. The findings suggest that the use of tocilizumab in patients with severe COVID-19 may be beneficial. The quicker recovery with less time spent on vasopressors and invasive mechanical ventilation is promising. Further clinical trials are required to validate the use of tocilizumab in the treatment of COVID-19 patients.
Written by Helen Massy,BSc.
Kewan, T., Covut, F., Al–Jaghbeer, M., Rose, L., Gopalakrishna, K. and Akbik, B., 2020. Tocilizumab for treatment of patients with severe COVID–19: A retrospective cohort study. EClinicalMedicine, p.100418.
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