1. Tocilizumab for severe COVID-19 related illness – A community academic medical center experience
- Author
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Todd Roberts, Vincent Armenio, Ashley E. Moody, Priscilla Dasilva, Steven C. Katz, Abdul Saied Calvino, Gabrielle Masse, Jason Laporte, Kapil S Meleveedu, John Miskovsky, Richa Tandon, Greg Allen, Joseph Meharg, Abd Abdelrahman, and Rabih El-Bizri
- Subjects
lcsh:Immunologic diseases. Allergy ,(IRB), Institutional review board ,(NIV), Noninvasive ventilation ,medicine.medical_specialty ,(PaO2/FiO2), Arterial oxygen partial pressure/fraction of inspired oxygen ,(CRP), C-reactive protein ,medicine.medical_treatment ,Immunology ,Disease ,(BMI), Body mass index ,Biochemistry ,Siltuximab ,Article ,(anti-IL-6/IL-6-R), Anti-IL-6/IL-6-Receptor ,Proinflammatory cytokine ,C-reactive protein ,chemistry.chemical_compound ,Tocilizumab ,Internal medicine ,medicine ,otorhinolaryngologic diseases ,Immunology and Allergy ,(SITC), Society for Immunotherapy of Cancer ,Interleukin 6 ,Molecular Biology ,Infectious disease ,IL-6 ,biology ,(ALC), Absolute Lymphocyte Count ,business.industry ,SARS-CoV-2 ,(SpO2), Peripheral capillary oxygen saturation ,(DNR/DNI), Do not resuscitate/do not intubate ,(ECMO), Extracorporeal membrane oxygenation ,Hematology ,medicine.disease ,(ARDS), Acute respiratory distress syndrome ,(CRS), Cytokine release syndrome ,Cytokine release syndrome ,Cytokine ,(RWMC), Roger Williams Medical Center ,chemistry ,(ESR), Erythrocyte sedimentation rate ,(RT-PCR), Reverse-transcriptase polymerase-chain-reaction ,biology.protein ,business ,lcsh:RC581-607 ,(LDH), Lactate dehydrogenase - Abstract
Highlights • COVID-19 can cause a hyperinflammatory state akin to cytokine release syndrome (CRS). • Our report shows the efficacy and safety of using anti-IL-6/IL-6-R therapy in 31 patients. • Treatment at the onset of severe CRS may be the ideal window for intervention. • Long term effects of these agents are currently lacking., The SARS-CoV-2 virus responsible for the COVID-19 pandemic can result in severe or fatal disease in a subset of infected patients. While the pathogenesis of severe COVID-19 disease has yet to be fully elucidated, an overexuberant and harmful immune response to the SARS-CoV-2 virus may be a pivotal aspect of critical illness in this patient population. The inflammatory cytokine, IL-6, has been found to be consistently elevated in severely ill COVID-19 patients, prompting speculation that IL-6 is an important driver of the pathologic process. The inappropriately elevated levels of inflammatory cytokines in COVID-19 patients is similar to cytokine release syndrome (CRS) observed in cell therapy patients. We sought to describe outcomes in a series of severely ill patients with COVID-19 CRS following treatment with anti-IL-6/IL-6-Receptor (anti-IL-6/IL-6-R) therapy, including tocilizumab or siltuximab. At our academic community medical center, we formed a multi-disciplinary committee for selecting severely ill COVID-19 patients for therapy with anti-IL-6 or IL-6-R agents. Key selection criteria included evidence of hyperinflammation, most notably elevated levels of C-reactive protein (CRP) and ferritin, and an increasing oxygen requirement. By the data cutoff point, we treated 31 patients with anti-IL-6/IL-6-R agents including 12 who had already been intubated. Overall, 27 (87%) patients are alive and 24 (77%) have been discharged from the hospital. Clinical responses to anti-IL-6/IL-6-R therapy were accompanied by significant decreases in temperature, oxygen requirement, CRP, IL-6, and IL-10 levels. Based on these data, we believe anti-IL-6/IL-6-R therapy can be effective in managing early CRS related to COVID-19 disease. Further study of anti-IL-6/IL-6-R therapy alone and in combination with other classes of therapeutics is warranted and trials are underway.
- Published
- 2020