Karthikkeyan Rajachandran, Giphy Susan Varghese, J Vinoth Kumar
Karthikkeyan Rajachandran*, Giphy Susan Varghese, J Vinoth Kumar
Medical Intensive Care Unit, PSG Hospitals, Coimbatore, Tamil Nadu, India
Volume - 16,
Issue - 2,
Year - 2023
Background: Tocilizumab, an interleukin-6 (IL-6) antagonist, is being evaluated for the management of covid-19 pneumonia. The objective of this study was to assess the effectiveness of Tocilizumab in severe covid-19 pneumonia. Methods: This was a retrospective, observational, single centre study performed in 121 patients diagnosed with severe covid-19 pneumonia. 83 patients received standard of care treatment whereas 38 patients received tocilizumab along with standard of care. Tocilizumab was administered intravenously at 8mg/kg (upto a maximum of 800mg). The second dose of Tocilizumab was given 12 to 24 hours apart. The primary outcome measure was ICU related and hospital related mortality. The secondary outcome measures were change in clinical status of patients measured by WHO (World Health Organisation) 7 category ordinary scale, changes in interleukin-6 (IL-6) levels, secondary infections and duration of ICU stay. Results: Tocilizumab was administered between 3-27 days after the patient reported symptoms ( a median of 10.9 days ) and between the 1st to 3rd day of ICU admission (median of 2.1 days) . In Tocilizumab group, 16(42.1%) of 38 patients died in ICU whereas in standard of care group, 27(32.53%) of 83 patients died. The difference in clinical status assessed using WHO (World Health Organisation) 7 category ordinary scale at 28 days between Tocilizumab group and standard of care group was not statistically significant (odds ratio 1.35, 95% confidence interval 0.61 to 2.97, p = 0.44). Conclusion: Tocilizumab plus standard care was not superior to standard care alone in reducing mortality and improving clinical outcomes at day 28.
Cite this article:
Karthikkeyan Rajachandran, Giphy Susan Varghese, J Vinoth Kumar. The effectiveness of Tocilizumab in severe covid 19 pneumonia among critically ill patients. Research Journal of Pharmacy and Technology 2023; 16(2):763-8. doi: 10.52711/0974-360X.2023.00130
Karthikkeyan Rajachandran, Giphy Susan Varghese, J Vinoth Kumar. The effectiveness of Tocilizumab in severe covid 19 pneumonia among critically ill patients. Research Journal of Pharmacy and Technology 2023; 16(2):763-8. doi: 10.52711/0974-360X.2023.00130 Available on: https://www.rjptonline.org/AbstractView.aspx?PID=2023-16-2-49
1. Giovanni Guaraldi, Marianna Meschiari, Alessandro Cozzi-Lepri, et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol 2020;2(8):e474–84. DOI:10.1016/S2665-9913(20)30173-9.
2. Rand Alattar, Tawheeda B. H. Ibrahim, Shahd H. Shaar, et al. Tocilizumab for the treatment of severe coronavirus disease 2019. J Med Virol. 2020;92(10):2042–49. DOI: 10.1002/jmv.25964.
3. Sarfaraz Ahmad, Ambreen Shoaib, Sajid Ali, Sarfaraz Alam et al. Epidemiology, risk, myths, pharmacotherapeutic management and socio economic burden due to novel COVID-19: A recent update. Research J. Pharm. and Tech 2020; 13(9):4435-4442. DOI: 10.5958/0974-360X.2020.00784.2.
4. Sonia Mor, Prem Saini , Subhash Kumar Wangnoo et al. Worldwide spread of COVID-19 Pandemic and risk factors among Co-morbid conditions especially Diabetes Mellitus in India. Research J. Pharm. and Tech 2020; 13(5):2530-2532. DOI: 10.5958/0974-360X.2020.00450.3.
5. Abbas Kinbar Kuser, Sagban Marja Tarar , Omar Mansib Kassid et al. CNS and COVID-19: Neurological symptoms of Hospitalized Patients with Coronavirus in Iraq: a surveying case sequences study. Research J. Pharm. and Tech. 2020; 13(12):6291-6294. DOI: 10.5958/0974-360X.2020.01094.X.
6. Rohit Kumar, Anshul Chawla, Gaganpreet et al. A Valuable insight to the novel deadly COVID-19: A Review. Res. J. Pharmacology and Pharmacodynamics.2020; 12(3):111-116. DOI: 10.5958/2321-5836.2020.00021.X.
7. Archana B. Chavhan, Pavan S. Jadhav, Satish Shelke. COVID 19: Outbreak, Structure and Current therapeutic strategies. Asian J. Pharm. Tech. 2021; 11(1):76-83. DOI: 10.5958/2231-5713.2021.00013.1.
8. Nensi Raytthatha, Isha Shah, Jigar Vyas. An Informative Review on screening of COVID-19 (SARS-COVID-II). Res. J. Pharma. Dosage Forms and Tech.2021; 13(3):259-265. DOI: 10.52711/0975-4377.2021.00043.
9. World Health Organization. Coronavirus disease 2019 (COVID 19) Situation Report 51 (11 March 2020). Geneva, Switzerland: World Health Organization;2020.
10. Vandna Dewangan, Ram Sahu, Trilochan Satapathy et al. The Exploring of Current Development status and the unusual Symptoms of Coronavirus Pandemic (Covid-19). Res. J. Pharmacology and Pharmacodynamics.2020; 12(4):172-176. DOI: 10.5958/2321-5836.2020.00031.2.
11. Shivom, Shambaditya Goswami, Nikita Pal. A Meticulous Interpretation on a Sanguinary Disease COVID-19. Res. J. Pharma. Dosage Forms and Tech.2020; 12(3):231-233. DOI: 10.5958/0975-4377.2020.00038.5.
12. Naveen Yadam, Ganta Suhasin. Prediction of COVID-19 severity associated with Pneumonia by chest CT scan and Serological results. Asian Journal of Pharmacy and Technology. 2021;11(3):198-202. DOI: 10.52711/2231-5713.2021.00032.
13. Zhe Xu , Lei Shi , Yijin Wang, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med.2020;8(4):420-22. DOI: 10.1016/S2213-2600(20)30076-X.
14. Nanshan Chen, Prof Min Zhou, Xuan Dong, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. DOI: 10.1016/S0140-6736(20)30211-7.
15. Chaolin Huang, Yeming Wang, Xingwang Li, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497‐506. DOI: 10.1016/S0140-6736(20)30183-5.
16. Noa Biran, Andrew Ip, Jaeil Ahn, et al. Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study. Lancet Rheumatol 2020;2(10):e603–13. DOI:10.1016/S2665-9913(20)30277-0.
17. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239-42. DOI: 10.1001/jama.2020.2648.
18. Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science 2020;368(6490):473-4. DOI: 10.1126/science.abb8925.
19. Vaninov N. In the eye of the COVID-19 cytokine storm. Nat Rev Immunol 2020;20:277. DOI: 10.1038/s41577-020-0305-6.
20. Isha Shah, Nensi Raytthatha, Jigar Vyas et al. A Systematic Review on COVID 19 Treatment and Management. Res. J. Pharma. Dosage Forms and Tech.2021; 13(3):230-238. DOI: 10.52711/0975-4377.2021.00039.
21. Viviane C Veiga, Joao A G G Prats, Danielle L C Farias, et al. Effect of tocilizumab on clinical outcomes at 15 days in patients with severe or critical coronavirus disease 2019: randomised controlled trial. BMJ 2021;372:n84. DOI: 10.1136/bmj.n84.
22. Pan Luo, Yi Liu, Lin Qiu, Xiulan Liu, Dong Liu, Juan L. Tocilizumab treatment in COVID‐19: A single center experience. J Med Virol. 2020;92(7):814–18.DOI: 10.1002/jmv.25801.
23. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395(10229):1033-4. DOI: 10.1016/S0140-6736(20)30628-0.
24. Rosas I, Brau N, Waters M, et al. Tocilizumab in hospitalized patients with COVID-19 pneumonia. medRxiv 2020.08.27.20183442. DOI:10.1101/2020.08.27.20183442.
25. Somers EC, Eschenauer GA, Troost JP, et al. Tocilizumab for treatment of mechanically ventilated patients with COVID-19. Clin Infect Dis 2021;73(2):e445-54. DOI: 10.1093/cid/ciaa954.
26. Tomasiewicz K, Piekarska A, Stempkowska-Rejek J, et al. Tocilizumab for patients with severe COVID-19: a retrospective, multi-center study. Expert Rev Anti Infect Ther 2021;19(1):93-100. DOI: 10.1080/14787210.2020.1800453.
27. Rossotti R, Travi G, Ughi N, et al, Niguarda COVID-19 Working Group. Safety and efficacy of anti-il6-receptor tocilizumab use in severe and critical patients affected by coronavirus disease 2019: A comparative analysis. J Infect 2020;81(4):e11-17. DOI:10.1016/j.jinf.2020.07.008.
28. Moreno-Perez O, Andres M, Leon-Ramirez JM, et al. Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of followup: A retrospective cohort study. J Autoimmun 2020;114:102523. DOI: 10.1016/j.jaut.2020.102523.
29. Klopfenstein T, Zayet S, Lohse A, et al, HNF Hospital Tocilizumab multidisciplinary team. Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients. Med Mal Infect 2020;50(5):397-400. DOI: 10.1016/j.medmal.2020.05.001.
30. Hermine O, Mariette X, Tharaux PL, et al. Effect of Tocilizumab vs usual care in adults hospitalized with COVID-19 and moderate or severe pneumonia: a randomized clinical trial. JAMA Intern Med 2021;181(1):32-40. DOI:10.1001/jamainternmed.2020.6820.
31. Quartuccio L, Sonaglia A, Pecori D, et al. Higher levels of IL-6 early after tocilizumab distinguish survivors from nonsurvivors in COVID-19 pneumonia: A possible indication for deeper targeting of IL-6. J Med Virol 2020;92(11):2852-2856. DOI: 10.1002/jmv.26149.
32. Nishimoto N, Terao K, Mima T, Nakahara H, Takagi N, Kakehi T. Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood 2008;112(10):3959-64. DOI:10.1182/blood-2008-05-155846.
33. Rania M Sarhan, Yasmin M. Madney, Ahmed E. Abou Warda, et.al. Therapeutic efficacy, mechanical ventilation, length of hospital stay, and mortality rate in severe COVID‐19 patients treated with tocilizumab. Int J Clin Pract 2021;75(6)e14079. DOI: 10.1111/ijcp.14079.