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Is There any Additional Benefit of Multiple Doses of Tocilizumab in COVID-19 Patients?

Mohsin S Mughal1, Ikwinder Kaur1, Mili Kakadia1

  • 1Internal Medicine, Monmouth Medical Center, Long Branch, USA.

Cureus
|January 25, 2021
PubMed

Insights

Multiple doses of tocilizumab (TCZ) did not improve outcomes for hospitalized COVID-19 patients. Mortality remained higher in patients receiving two or more TCZ doses compared to one, indicating no added benefit.

Area of Science:

  • Immunology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • COVID-19 can cause a cytokine storm, leading to multiorgan dysfunction.
  • Interleukin-6 (IL-6) and GM-CSF are key drivers of inflammation and endothelial dysfunction in severe COVID-19.
  • IL-6 receptor inhibitors (IL6ri) are used to mitigate these effects, but optimal dosing strategies remain unclear.

Purpose of the Study:

  • To investigate if multiple doses of tocilizumab (TCZ) prevent clinical deterioration in hospitalized COVID-19 patients.
  • To compare all-cause mortality and secondary outcomes between patients receiving one dose versus two or more doses of TCZ.

Main Methods:

  • Retrospective, single-center study of 270 hospitalized COVID-19 patients.
  • Eighty-one patients received TCZ, divided into two cohorts: one dose (n=50) and ≥ two doses (n=31).
  • Primary outcome was all-cause mortality; secondary outcomes included ICU admission, AKI, ARDS, ACI, thrombotic events, septic shock, and hospital stay.

Main Results:

  • All-cause mortality was higher in the cohort receiving ≥ two doses of TCZ (41.9%) compared to the one-dose cohort.
  • Multiple TCZ doses did not demonstrate additional benefit in preventing the primary outcome (all-cause mortality).
  • Secondary outcomes, including ICU admission, organ injury (AKI, ARDS, ACI), thrombotic events, septic shock, and hospital stay, were not significantly improved by multiple TCZ doses.

Conclusions:

  • Multiple doses of TCZ did not confer additional benefits for hospitalized COVID-19 patients regarding mortality or other clinical outcomes.
  • Current evidence does not support the use of multiple TCZ doses over a single dose for managing severe COVID-19.
  • Further research may be needed to clarify the role and optimal use of IL-6 inhibition in COVID-19 management.

Keywords:
covid-19il-6 receptor inhibitorsmortalitytocilizumab

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