Applied Clinical Pharmacology in a Crisis: Interleukin-6 Axis Blockade and COVID-19

Abstract

The global pandemic of coronavirus disease 2019 (COVID-19) represents an emergent threat to the public health. Mitigation strategies have been employed to varying effect in many Western nations. Treatment strategies to effectively address COVID-19 and equitably distribute resources are needed, especially in overwhelmed hospitals.

Figure 1

Proposed treatment strategy for patients with moderate or severe COVID‐19 with high risk for clinical decompensation using tocilizumab titration. Most hospitalized patients with COVID‐19 infections are potential recipients of IL‐6 axis‐suppressing therapy, with priority for those patients at high risk for decompensation and death. Following baseline clinical and laboratory‐based risk stratification, patients will receive an initial dose of tocilizumab. Studies need to be performed to determine the minimum effective dose in this context, but it may be 100 mg or lower. Supportive clinical care continues for 24 hours after the initial tocilizumab dose, at which point repeat clinical and biochemical assessments are performed. If clinical stability or clinical improvement and biochemical evidence of IL‐6 axis suppression, continuation of supportive clinical care without repeat dosing is indicated. If clinical decompensation or biochemical evidence of insufficient IL‐6 axis suppression, patients receive an additional dose of tocilizumab, with reconsideration of additional doses at 24‐hour intervals. COVID‐19, coronavirus disease 2019; h, hours; PaO2, arterial oxygen partial pressure; SpO2, peripheral blood oxygen saturation; Temp, temperature.