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Using Reference Reagents to Confirm Robustness of Cytokine Release Assays for the Prediction of Monoclonal Antibody Safety
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Use of Tocilizumab for COVID-19-Induced Cytokine Release Syndrome: A Cautionary Case Report

Jared Radbel1, Navaneeth Narayanan2, Pinki J Bhatt3

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.

Chest
|April 29, 2020
PubMed

Insights

Tocilizumab, an IL-6 inhibitor, showed limited efficacy in treating severe COVID-19 cytokine release syndrome (CRS) and secondary hemophagocytic lymphohistiocytosis (sHLH). Further clinical trials are needed to determine optimal use of tocilizumab for COVID-19 complications.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19, a global pandemic, presents with diverse manifestations including cytokine release syndrome (CRS) and secondary hemophagocytic lymphohistiocytosis (sHLH).
  • Tocilizumab, an interleukin-6 (IL-6) receptor antagonist, is a potential anti-cytokine therapy for severe COVID-19, but its efficacy remains under investigation.

Observation:

  • Two cases of COVID-19 patients with CRS progressing to sHLH despite tocilizumab treatment are presented.
  • One patient developed viral myocarditis, raising concerns about tocilizumab's safety and clinical utility in this context.

Findings:

  • Tocilizumab treatment did not prevent disease progression to sHLH in these two COVID-19 patients.
  • The cases challenge the established role of tocilizumab in managing severe COVID-19-associated CRS and sHLH.

Implications:

  • These findings underscore the urgent need for rigorous clinical trials to establish optimal patient selection and treatment timing for tocilizumab in COVID-19.
  • Further research is critical to clarify the safety and effectiveness of IL-6 blockade in managing COVID-19-induced hyperinflammation.

Keywords:
COVID-19critical carecytokinesviral disease

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