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. 2021 Mar;25(3):260-266.
doi: 10.5005/jp-journals-10071-23747.

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients

Sudhir Bhandari  1 , Govind Rankawat  1 , Ajeet Singh  1
Affiliations

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients

Sudhir Bhandari et al. Indian J Crit Care Med. 2021 Mar.

Abstract

Background: Tocilizumab (TCZ), a monoclonal antibody against the most prevalent cytokine interleukin-6 (IL-6), is an emerging therapeutic option for COVID-19 infections. The present study was undertaken to assess the therapeutic response of TCZ therapy in severely or critically ill COVID-19 patients and its role as an effective modality of management. Methods: The present retrospective observational study included 30 admitted severely or critically ill COVID-19 patients, treated with TCZ therapy on behalf of raised IL-6 levels. The patients' data concerning medical history, clinical manifestation, arterial blood gas analysis, mode of oxygenation, radiological imaging, and outcome were extracted from their medical records and compared pre- and post-TCZ infusion. Results: All patients of the study group had symptomatic presentations with a mean PaO2/FiO2 (P/F) ratio of 205.41 before TCZ infusion. All patients had a raised IL-6 level (mean value 206.56 pg/mL) that was extremely elevated in 90% of patients. Infusion of TCZ dramatically reduced mean body temperature (100.78-99.32°F) and the requirement for supplemental oxygen (68-48%) and improved mean SpO2 (86-89%) and mean P/F ratio (208-240) within 24 hours. Three patients on noninvasive ventilation were weaned off after TCZ infusion. Serum levels of IL-6 were raised initially but declined within 3-5 days of post-TCZ infusion. Conclusion: TCZ appears to be an effective therapeutic option in severely or critically ill COVID-19 patients with raised IL-6 levels. TCZ immediately improves the clinical status of patients by a probable mechanism of inhibition of cytokine storm and reduces COVID-19-related mortalities. How to cite this article: Bhandari S, Rankawat G, Singh A. Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients. Indian J Crit Care Med 2021;25(3):260-266.

Keywords: COVID-19; Cytokine storm; Interleukin-6; Tocilizumab.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A to F
Figs 1A to F
The values of maximum body temperature, oxygen saturation at room air (SpO2), concentration of inhaled oxygen (FiO2), partial pressure of oxygen in blood (PaO2) at room air, PaO2/FiO2 (P/F) ratio, and serum level of IL-6 before and after the treatment with tocilizumab (TCZ) of 30 patients with COVID-19. (A) Maximum body temperature decreased significantly after treatment with TCZ and returned to normal in all patients; (B) SpO2 improved with TCZ and returned to normal in all patients; (C) Concentration of FiO2 significantly reduced after TCZ infusion and the majority of patients weaned off oxygen and returned to room air; (D and E) PaO2 and P/F ratio were significantly improved with the infusion of TCZ and returned to normal in nearly all patients; (F) IL-6 had a dramatic variation after TCZ infusion with an initial peak spike followed by a reduction in the serum level of IL-6 after three days
Figs 2A and B
Figs 2A and B
HRCT chest of a 52-year-old male with severe COVID-19 disease. (A) Before TCZ infusion showed bilateral diffuse ground-glass opacities with a CT severity score of 20/25; (B) After TCZ infusion with a clinical improvement, suggestive of reduced opacities with a CT severity score of 9/25
See this image and copyright information in PMC

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