Tocilizumab shows promise for SARS-CoV-2 pneumonia

  • Jordan SC & al.
  • Clin Infect Dis
  • 23 Jun 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A compassionate use study of tocilizumab, an inhibitor of IL-6, finds reduced inflammation from cytokine storm and low mortality in mostly intubated patients with SARS-CoV-2 pneumonia.

Why this matters

  • SARS-CoV-2 pneumonia is linked to high mortality, and treatments are limited.
  • The cytokine storm that tocilizumab targets appears to increase morbidity and mortality.

Study design

  • Single-center consecutive case series of mostly intubated patients (21 of 27 total) hospitalized with SARS-CoV-2 pneumonia.
  • Patients with confirmed SARS-CoV-2 infection and pneumonia were given a single dose of intravenous tocilizumab 400 mg.
  • Funding: None.

Key results

  • IL-6 was the predominant cytokine (mean, 356.07±616 pg/mL vs normal 0-5 pg/mL; P<.001>
  • C-reactive protein (CRP) levels were reduced within 72 hours of treatment (pretocilizumab median 160 mg/L vs posttocilizumab median 20 mg/L; P<.001>
  • 3 of 4 patients not showing rapid declines in CRP had poor outcomes.
  • Requirements for oxygen and vasopressor decreased over the first week posttocilizumab.
  • Of the 21 patients who required mechanical ventilation, 15 (71%) were extubated over a median of 8 days posttreatment, and 9 (43%) were discharged over the study period.
  • Only 2 (10%) intubated patients died, unrelated to tocilizumab therapy.
  • Only minimal adverse events and serious adverse events were seen.

Limitations

  • Single-center study with small sample size.
  • No control group.
  • Observational.