Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6
BackgroundTocilizumab (TCZ), an interleukin-6 receptor antibody, has previously been used for treating patients with the coronavirus disease 2019 (COVID-19), but there is a lack of data regarding the administration timing of TCZ.ObjectivesThis study aimed to evaluate the timing and efficacy of TCZ i...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-04-01
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| Series: | Frontiers in Molecular Biosciences |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmolb.2021.651662/full |
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| author | Pan Li Pan Li Zhengmao Lu Zhengmao Lu Qiang Li Qiang Li Zhenmeng Wang Zhenmeng Wang Yan Guo Yan Guo Chen Cai Chen Cai Shengyun Wang Shengyun Wang Peng Liu Peng Liu Xiaoping Su Yi Huang Yuchao Dong Wenjuan Qiu Wenjuan Qiu Yueming Ling Yueming Ling Lonny Yarmus Fengming Luo Li Zeng Li Zeng Chong Bai Wei Zhang Wei Zhang |
| author_facet | Pan Li Pan Li Zhengmao Lu Zhengmao Lu Qiang Li Qiang Li Zhenmeng Wang Zhenmeng Wang Yan Guo Yan Guo Chen Cai Chen Cai Shengyun Wang Shengyun Wang Peng Liu Peng Liu Xiaoping Su Yi Huang Yuchao Dong Wenjuan Qiu Wenjuan Qiu Yueming Ling Yueming Ling Lonny Yarmus Fengming Luo Li Zeng Li Zeng Chong Bai Wei Zhang Wei Zhang |
| author_sort | Pan Li |
| collection | DOAJ |
| description | BackgroundTocilizumab (TCZ), an interleukin-6 receptor antibody, has previously been used for treating patients with the coronavirus disease 2019 (COVID-19), but there is a lack of data regarding the administration timing of TCZ.ObjectivesThis study aimed to evaluate the timing and efficacy of TCZ in the treatment of patients with COVID-19.MethodsLaboratory-confirmed patients with COVID-19 with an elevated interleukin-6 (IL-6) level (>10 pg/ml) were offered TCZ intravenously for compassionate use. Clinical characteristics, laboratory tests, and chest imaging before and after the administration of TCZ were retrospectively analyzed.ResultsA total of 58 consecutive patients who met the inclusion criteria and with no compliance to the exclusion criteria were included. Of these 58 patients, 39 patients received TCZ treatment, and 19 patients who declined TCZ treatment were used as the control cohort. In the TCZ-treatment group, 6 patients (15.4%) were in mild condition, 16 (41.0%) were in severe condition, and 17 (43.6%) were in critical condition. After TCZ treatment, the condition of 27 patients (69.2%) improved and 12 (30.8%) died. Compared with the improvement group, patients in the death group had higher baseline levels of IL-6 (P = 0.0191) and procalcitonin (PCT) (P = 0.0003) and lower lymphocyte percentage (LYM) (P = 0.0059). Patients receiving TCZ treatment had better prognoses than those without TCZ treatment (P = 0.0273). Furthermore, patients with a baseline IL-6 level of ≥100 pg/ml in the TCZ-treatment group had poorer clinical outcomes than those with an IL-6 level of <100 pg/ml (P = 0.0051).ConclusionThe administration of TCZ in an early stage of cytokine storm (IL-6 level < 100 pg/ml) may effectively improve the clinical prognosis of patients with COVID-19 by blocking the IL-6 signal pathway. |
| first_indexed | 2024-12-20T09:56:19Z |
| format | Article |
| id | doaj.art-086b3d3dcec248f19813f76148036a52 |
| institution | Directory Open Access Journal |
| issn | 2296-889X |
| language | English |
| last_indexed | 2024-12-20T09:56:19Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Molecular Biosciences |
| spelling | doaj.art-086b3d3dcec248f19813f76148036a522022-12-21T19:44:27ZengFrontiers Media S.A.Frontiers in Molecular Biosciences2296-889X2021-04-01810.3389/fmolb.2021.651662651662Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6Pan Li0Pan Li1Zhengmao Lu2Zhengmao Lu3Qiang Li4Qiang Li5Zhenmeng Wang6Zhenmeng Wang7Yan Guo8Yan Guo9Chen Cai10Chen Cai11Shengyun Wang12Shengyun Wang13Peng Liu14Peng Liu15Xiaoping Su16Yi Huang17Yuchao Dong18Wenjuan Qiu19Wenjuan Qiu20Yueming Ling21Yueming Ling22Lonny Yarmus23Fengming Luo24Li Zeng25Li Zeng26Chong Bai27Wei Zhang28Wei Zhang29Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Anesthesia, Third Affiliated Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Special Clinic, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Emergency and Critical Care Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, ChinaDepartment of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China0School of Basic Medicine, Wenzhou Medical University, Wenzhou, China1Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China1Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, China2Department of Cardiovascular ICU, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, China3Department of Clinical Laboratory Science of No. 910 Hospital of PLA Joint Support Force, Quanzhou, China4Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, United States5Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, China6Department of Organ Transplantation, Changhai Hospital, Second Military Medical University, Shanghai, China1Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Infection Diseases No. 1, The Maternal and Child Health Hospital of Hubei Province, Wuhan, China1Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, ChinaBackgroundTocilizumab (TCZ), an interleukin-6 receptor antibody, has previously been used for treating patients with the coronavirus disease 2019 (COVID-19), but there is a lack of data regarding the administration timing of TCZ.ObjectivesThis study aimed to evaluate the timing and efficacy of TCZ in the treatment of patients with COVID-19.MethodsLaboratory-confirmed patients with COVID-19 with an elevated interleukin-6 (IL-6) level (>10 pg/ml) were offered TCZ intravenously for compassionate use. Clinical characteristics, laboratory tests, and chest imaging before and after the administration of TCZ were retrospectively analyzed.ResultsA total of 58 consecutive patients who met the inclusion criteria and with no compliance to the exclusion criteria were included. Of these 58 patients, 39 patients received TCZ treatment, and 19 patients who declined TCZ treatment were used as the control cohort. In the TCZ-treatment group, 6 patients (15.4%) were in mild condition, 16 (41.0%) were in severe condition, and 17 (43.6%) were in critical condition. After TCZ treatment, the condition of 27 patients (69.2%) improved and 12 (30.8%) died. Compared with the improvement group, patients in the death group had higher baseline levels of IL-6 (P = 0.0191) and procalcitonin (PCT) (P = 0.0003) and lower lymphocyte percentage (LYM) (P = 0.0059). Patients receiving TCZ treatment had better prognoses than those without TCZ treatment (P = 0.0273). Furthermore, patients with a baseline IL-6 level of ≥100 pg/ml in the TCZ-treatment group had poorer clinical outcomes than those with an IL-6 level of <100 pg/ml (P = 0.0051).ConclusionThe administration of TCZ in an early stage of cytokine storm (IL-6 level < 100 pg/ml) may effectively improve the clinical prognosis of patients with COVID-19 by blocking the IL-6 signal pathway.https://www.frontiersin.org/articles/10.3389/fmolb.2021.651662/fullcytokine storminterleukin-6SARS-CoV-2tocilizumab (TCZ)coronavirus – COVID-19 |
| spellingShingle | Pan Li Pan Li Zhengmao Lu Zhengmao Lu Qiang Li Qiang Li Zhenmeng Wang Zhenmeng Wang Yan Guo Yan Guo Chen Cai Chen Cai Shengyun Wang Shengyun Wang Peng Liu Peng Liu Xiaoping Su Yi Huang Yuchao Dong Wenjuan Qiu Wenjuan Qiu Yueming Ling Yueming Ling Lonny Yarmus Fengming Luo Li Zeng Li Zeng Chong Bai Wei Zhang Wei Zhang Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 Frontiers in Molecular Biosciences cytokine storm interleukin-6 SARS-CoV-2 tocilizumab (TCZ) coronavirus – COVID-19 |
| title | Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 |
| title_full | Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 |
| title_fullStr | Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 |
| title_full_unstemmed | Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 |
| title_short | Administration Timing and Efficacy of Tocilizumab in Patients With COVID-19 and Elevated IL-6 |
| title_sort | administration timing and efficacy of tocilizumab in patients with covid 19 and elevated il 6 |
| topic | cytokine storm interleukin-6 SARS-CoV-2 tocilizumab (TCZ) coronavirus – COVID-19 |
| url | https://www.frontiersin.org/articles/10.3389/fmolb.2021.651662/full |
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