Compassionate Use of Tocilizumab for Treatment of SARS-CoV-2 Pneumonia. (23rd June 2020)

• Record Type: Journal Article
• Authors: Jordan, Stanley C; Zakowski, Phillip; Tran, Hai P; Smith, Ethan A; Gaultier, Cyril; Marks, Gregory; Zabner, Rachel; Lowenstein, Hayden; Oft, Jillian; Bluen, Benjamin; Le, Catherine; Shane, Rita; Ammerman, Noriko; Vo, Ashley; Chen, Peter; Kumar, Sanjeev; Toyoda, Mieko; Ge, Shili; Huang, Edmund
• Is Part Of: Clinical infectious diseases. Volume 71:Number 12(2020)
• Page Start: 3168
• Page End: 3173
• Publication Date: 2020-06-23
• Subjects: COVID-19 -- SARS-CoV2 -- acute respiratory distress syndrome -- interleukin 6; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa812
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Preliminary data from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patients indicate that a cytokine storm may increase morbidity and mortality. Tocilizumab (anti-IL-6R) is approved by the Food and Drug Administration for treatment of cytokine storm associated with chimeric antigen receptor T-cell therapy. Here we examined compassionate use of tocilizumab in patients with SARS-CoV-2 pneumonia. Methods: We report on a single-center study of tocilizumab in hospitalized patients with SARS-CoV-2 pneumonia. All patients had confirmed SARS-CoV-2 pneumonia and oxygen saturations <90% on oxygen support with most intubated. We examined clinical and laboratory parameters including oxygen and vasopressor requirements, cytokine profiles, and C-reactive protein (CRP) levels pre- and post-tocilizumab treatment. Results: Twenty-seven SARS-CoV-2 pneumonia patients received one 400 mg dose of tocilizumab. Interleukin (IL)-6 was the predominant cytokine detected at tocilizumab treatment. Significant reductions in temperature and CRP were seen post-tocilizumab. However, 4 patients did not show rapid CRP declines, of whom 3 had poorer outcomes. Oxygen and vasopressor requirements diminished over the first week post-tocilizumab. Twenty-two patients required mechanical ventilation; at last follow-up, 16 were extubated. Adverse events and serious adverse events were minimal, but 2 deaths (7.4%) occurred that were felt unrelated to tocilizumab. Conclusions: Compared to published reports on the morbidity and mortality associated with SARS-CoV-2, tocilizumab appears to offer benefits in reducing inflammation, oxygen requirements, vasopressor support, and mortality. The rationale for tocilizumab treatment is supported by detection of IL-6 in pathogenic levels in all patients. Additional doses of tocilizumab may be needed for those showing slow declines in CRP. Proof of efficacy awaits randomized, placebo-controlled clinical trials. Abstract : We found that a single dose of tocilizumab 400 mg given intravenously for compassionate use in 27 patients with severe SARS-CoV-2 pneumonia appeared to offer benefits in reducing inflammation, oxygen requirements, vasopressor support, and mortality.