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Tocilizumab Treatment Effect on Iron Homeostasis in Severe COVID-19 Patients
Dmitri Guz1, Anat Gafter-Gvili1, Nirit Lev2
1Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Tocilizumab treatment for severe COVID-19 significantly increases serum iron and transferrin saturation while decreasing ferritin. This iron shift may negatively impact patient outcomes and potentially enhance viral replication.
Area of Science:
- Biochemistry
- Immunology
- Infectious Diseases
Background:
- Tocilizumab is investigated for severe COVID-19 treatment.
- Potential adverse effects of tocilizumab on iron metabolism are explored.
Purpose of the Study:
- To determine if tocilizumab administration increases serum iron in severe COVID-19 patients.
- To assess the impact on iron-related laboratory markers and potential clinical outcome associations.
Main Methods:
- Observational, retrospective cohort study of 15 ICU-admitted severe COVID-19 patients.
- Collected laboratory data: serum iron, ferritin, transferrin saturation, hemoglobin, CRP before and up to 72h post-tocilizumab.
Main Results:
- Tocilizumab significantly increased serum iron (26 to 79 μg/dL) and transferrin saturation (15% to 41%) (p < 0.001).
- A significant decrease in serum ferritin levels was observed (1,921 to 1,258 ng/mL) (p = 0.027).
Conclusions:
- Tocilizumab treatment profoundly alters iron metabolism in severe COVID-19 patients.
- Increased iron availability and transferrin saturation, with decreased ferritin, may be an adverse effect.
- This iron shift could potentially potentiate viral replication.
Background:
Tocilizumab has been proposed as an effective treatment for severe COVID-19. We aimed to investigate whether tocilizumab administration is associated with increased availability of serum iron which may possibly be associated with adverse effects on clinical outcomes.
Methods:
We performed an observational, retrospective cohort study. We included adults, who were hospitalized in ICU with the diagnosis of severe COVID-19 infection eligible for tocilizumab treatment. Laboratory data including serum iron, ferritin, transferrin saturation, hemoglobin, and C-reactive protein levels of all patients were collected shortly before and 24 h, 48 h, and 72 h after tocilizumab administration.
Results:
During the study period, 15 patients fulfilled the inclusion criteria and were eligible to receive tocilizumab treatment. Tocilizumab therapy was associated with a prominent increase in serum iron and transferrin saturation levels (26 ± 13 μg/dL and 15 ± 8% before treatment and 79 ± 32 μg/dL and 41 ± 15% 72 h after treatment, respectively, p < 0.001) and decrease in serum ferritin levels (1,921 ± 2,071 ng/mL before and 1,258 ± 1,140 ng/mL 72 h after treatment, p = 0.027).
Conclusion:
Treatment of severe COVID-19 patients with tocilizumab is associated with a profound increase in serum iron and ferritin saturation levels along with a decrease in ferritin levels. This may represent an undesirable side effect that may potentiate viral replication.
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