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Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6

Pan Li1,2, Zhengmao Lu2,3, Qiang Li2,4

  • 1Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.

Frontiers in Molecular Biosciences
|May 3, 2021
PubMed
Abstract

Insights

Early administration of tocilizumab (TCZ) for COVID-19 patients with elevated interleukin-6 (IL-6) levels may improve outcomes. This study found TCZ treatment led to better prognoses, especially when IL-6 levels were below 100 pg/ml.

Area of Science:

  • Immunology
  • Virology
  • Critical Care Medicine

Background:

  • Tocilizumab (TCZ), an interleukin-6 receptor antibody, has been explored for treating COVID-19.
  • Limited data exists on the optimal timing for TCZ administration in COVID-19 patients.
  • Elevated interleukin-6 (IL-6) is a key marker in severe COVID-19 pathogenesis.

Purpose of the Study:

  • To evaluate the efficacy and optimal timing of TCZ administration in COVID-19 patients.
  • To assess the impact of TCZ on clinical outcomes in relation to IL-6 levels.
  • To compare prognoses between TCZ-treated and untreated COVID-19 patients.

Main Methods:

  • Retrospective analysis of laboratory-confirmed COVID-19 patients with IL-6 >10 pg/ml.
  • TCZ administered intravenously for compassionate use.
  • Comparison of clinical characteristics, laboratory data, and chest imaging pre- and post-TCZ.

Main Results:

  • 39 patients received TCZ; 19 served as a control group.
  • TCZ treatment improved the condition of 69.2% of patients; 30.8% died.
  • Early TCZ administration (IL-6 <100 pg/ml) correlated with better clinical outcomes and prognoses compared to untreated patients.

Conclusions:

  • Early intervention with TCZ during the cytokine storm phase (IL-6 <100 pg/ml) can improve COVID-19 prognosis.
  • Blocking the IL-6 signal pathway with TCZ is a potential therapeutic strategy.
  • Higher baseline IL-6 and procalcitonin levels, and lower lymphocyte percentage, were associated with mortality.
Keywords:
SARS-CoV-2coronavirus – COVID-19cytokine storminterleukin-6tocilizumab (TCZ)

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