Higher levels of IL‐6 early after tocilizumab distinguish survivors from nonsurvivors in COVID‐19 pneumonia: A possible indication for deeper targeting of IL‐6. Issue 11 (22nd July 2020)

• Record Type: Journal Article
• Authors: Quartuccio, Luca; Sonaglia, Arianna; Pecori, Davide; Peghin, Maddalena; Fabris, Martina; Tascini, Carlo; De Vita, Salvatore
• Other Names: Luo Guangxiang (George) guestEditor.; Ly Hinh guestEditor.; Gao Shou‐Jiang guestEditor.
• Is Part Of: Journal of medical virology. Volume 92:Issue 11(2020)
• Page Start: 2852
• Page End: 2856
• Publication Date: 2020-07-22
• Subjects: coronavirus -- COVID‐19 -- cytokine -- interleukin‐6 -- tocilizumab; Virology -- Periodicals; 616
• DOI: 10.1002/jmv.26149
• Languages: English
• ISSNs: 0146-6615

Abstract

Abstract: Introduction: The most serious COVID‐19 deriving from severe acute respiratory syndrome coronavirus 2 causes a cytokine release storm and it is associated with worse outcomes. In COVID‐19 patients, interleukin‐6 (IL‐6) levels are significantly elevated. Blocking IL‐6 preliminarily resulted in the improvement of this hyperinflammatory state. It is unknown which patients could require higher doses of tocilizumab to get out of the cytokine storm. Materials and Methods: Twenty‐four patients affected by COVID‐19 pneumonia were included. All the patients underwent tocilizumab 8 mg/kg intravenously and were tested for serum IL‐6 24 to 48 hours before and 12 to 48 hours after tocilizumab infusion. Comparisons between survivors and nonsurvivors were performed. Results: Eighteen patients were discharged, while six patients died, with no clinical or laboratory differences between the two groups at baseline. IL‐6 was not different at baseline ( P = .41), while 24 to 48 hours post‐tocilizumab IL‐6 serum levels were significantly higher in nonsurvivors than in survivors (2398.5 [430.5‐9372] vs 290.5 [58.5‐1305.5] pg/mL, P = .022). Serum IL‐6 post‐tocilizumab showed a good predictive ability to discriminate survivors from nonsurvivors (area under the curve, 0.815; 95% confidence interval, 0.63‐0.99, P = .02). Conclusion: Repeated measurement of the serum level of IL‐6 early after tocilizumab may distinguish nonsurvivors from survivors and support the choice of deeper targeting IL‐6 in COVID‐19 pneumonia. Highlights: IL‐6 could be a useful biomarker for severity of COVID‐19. The highest burden of inflammation may be revealed by IL‐6 levels after tocilizumab. IL‐6 levels before and after tocilizumab may indicate how to improve IL‐6 targeting therapy in COVID‐19.