Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series
The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of h...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-07-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096211037442 |
| _version_ | 1818718613713977344 |
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| author | Beatriz Amorim Beltrão RN, PhD Rafael Cabral Teixeira MD Diego Bastos Porto MD, MSc |
| author_facet | Beatriz Amorim Beltrão RN, PhD Rafael Cabral Teixeira MD Diego Bastos Porto MD, MSc |
| author_sort | Beatriz Amorim Beltrão RN, PhD |
| collection | DOAJ |
| description | The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab. |
| first_indexed | 2024-12-17T19:53:50Z |
| format | Article |
| id | doaj.art-0b3c3bb71bd44e70bc3c8e71298a6951 |
| institution | Directory Open Access Journal |
| issn | 2324-7096 |
| language | English |
| last_indexed | 2024-12-17T19:53:50Z |
| publishDate | 2021-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj.art-0b3c3bb71bd44e70bc3c8e71298a69512022-12-21T21:34:39ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962021-07-01910.1177/23247096211037442Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case SeriesBeatriz Amorim Beltrão RN, PhD0Rafael Cabral Teixeira MD1Diego Bastos Porto MD, MSc2Walter Cantídio Federal University Hospital, Fortaleza, Ceará, BrazilSão Camilo Cura D’Ars Hospital, Fortaleza, Ceará, BrazilSão Camilo Cura D’Ars Hospital, Fortaleza, Ceará, BrazilThe cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab.https://doi.org/10.1177/23247096211037442 |
| spellingShingle | Beatriz Amorim Beltrão RN, PhD Rafael Cabral Teixeira MD Diego Bastos Porto MD, MSc Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series Journal of Investigative Medicine High Impact Case Reports |
| title | Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series |
| title_full | Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series |
| title_fullStr | Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series |
| title_full_unstemmed | Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series |
| title_short | Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series |
| title_sort | hyperinflammation in covid 19 obese patients treated with tocilizumab a successful case series |
| url | https://doi.org/10.1177/23247096211037442 |
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