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Editorial
. 2020 Jul;20(7):717-723.
doi: 10.1080/14712598.2020.1770222. Epub 2020 Jun 4.

Tocilizumab: from the rheumatology practice to the fight against COVID-19, a virus infection with multiple faces

Miguel A González-Gay  1   2   3 , José Mayo  4 , Santos Castañeda  5 , José M Cifrián  6 , José Hernández-Rodríguez  7
Affiliations
Editorial

Tocilizumab: from the rheumatology practice to the fight against COVID-19, a virus infection with multiple faces

Miguel A González-Gay et al. Expert Opin Biol Ther. 2020 Jul.
No abstract available

Keywords: COVID-19; Chimeric antigen receptor (CAR) T cell‐induced cytokine release syndrome; anakinra; colchicine; coronavirus; inflammation; interleukin-6; macrophage activation syndrome; tocilizumab.

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Figures

Figure 1.
Figure 1.
Pleiotropic effects of interleukin-6 (IL-6).
Figure 2A.
Figure 2A.
Treatment protocol for COVID-19 – Part I. (1) Remdesivir (from Gilead Sciences): loading dose of 200 mg i. v. on day 1, then 100 mg i.v. for the following 9 days. Only antiviral likely active, trials currently ongoing.(2) Hydroxychloroquine (DOLQUINE®): 200 mg per tablet; 2 tablets (400 mg)/12 hours the first 24 hours, and subsequently, 1 tablet (200 mg)/12 hours; duration of treatment 7–14 days.(3) Colchicine (COLCHICINA SEID®): 0.5 mg per tablet; 1 tablet (0.5 mg)/12 h for 3 days, followed by 0.5 mg/day during a total of 7 days.(4) Methylprednisolone (URBASON®): 250 mg i.v./day x 3 days.(5) Tocilizumab (RoACTEMRA®): if possible, an i.v. dose of 8 mg/Kg. However, due to a shortage of stock, a dose per patient was authorized, of 600 mg (if weight ≥75 Kg) or 400 mg (if weight <75 Kg).* Additional dose of tocilizumab if available or a similar anti-IL6 agent (e.g. sarilumab, siltuximab) or anakinra (according to doses in Part II – Figure 2B).** Specified in the following section (ICU)
Figure 2B.
Figure 2B.
Treatment protocol for COVID-19 – Part II.Adapted with permission from the updated protocol proposed on 20 April 2020, by Dr. Mayo at Hospital Galdakao, Bizkaia, Spain (anticoagulation recommendations not included).
See this image and copyright information in PMC

References

    1. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020. April 29:202005615. [Epub ahead of print]. doi:10.1073/pnas.2005615117. - DOI - PMC - PubMed

    2. •• Outstanding report of an initial Chinese series of 20 patients with severe COVID-19 treated with tocilizumab with satisfactory results.

    1. Toniati P, Piva S, Cattalini M, et al. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020. May 3:102568. [Epub ahead of print]. - PMC - PubMed

    2. •• A study-series of 100 consecutive patients with confirmed severe COVID-19 requiring ventilatory support who were treated with intravenous tocilizumab, obtaining rapid, sustained, and significant clinical improvement.

    1. Srirangan S, Choy EH.. The role of interleukin 6 in the pathophysiology of rheumatoid arthritis. Ther Adv Musculoskelet Dis. 2010;2:247–256. - PMC - PubMed

    2. •• Excellent review on the role of IL-6 in the mechanisms associated with inflammation in rheumatoid arthritis. It describes in an elegant way the inflammatory pathways activated by IL-6.

    1. Sebba A. Tocilizumab: the first interleukin-6-receptor inhibitor. Am J Health Syst Pharm. 2008;65:1413–1418. - PubMed

    2. • In this report the author provided useful information on the pharmacology, pharmacokinetics, clinical efficacy, safety, and role of tocilizumab in rheumatoid arthritis

    1. Johnson DE, O’Keefe RA, Grandis JR. Targeting the IL-6/JAK/STAT3 signalling axis in cancer. Nat Rev Clin Oncol. 2018;15:234–248. - PMC - PubMed

    2. •• Review on the role of IL-6/JAK/STAT3 signalling in the tumor microenvironment and the status of preclinical and clinical investigations of agents targeting this pathway. The authors also discussed the potential of combining IL-6/JAK/STAT3 inhibitors with therapeutic agents directed against immune-checkpoint inhibitor.

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