Appropriate use of tocilizumab in COVID-19 infection
Objective: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-d...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-10-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971220305804 |
| _version_ | 1818218062527070208 |
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| author | Şiran Keske Süda Tekin Bilgin Sait Pelin İrkören Mahir Kapmaz Cansu Çimen Semra Uğur İrfan Çelebi Veli Oğuzalp Bakır Erhan Palaoğlu Evren Şentürk Benan Çağlayan Nahit Çakar Levent Tabak Önder Ergönül |
| author_facet | Şiran Keske Süda Tekin Bilgin Sait Pelin İrkören Mahir Kapmaz Cansu Çimen Semra Uğur İrfan Çelebi Veli Oğuzalp Bakır Erhan Palaoğlu Evren Şentürk Benan Çağlayan Nahit Çakar Levent Tabak Önder Ergönül |
| author_sort | Şiran Keske |
| collection | DOAJ |
| description | Objective: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. Results: Forty-three patients were included: 70% were male; the median age was 64 years (minimum–maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. Conclusion: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes. |
| first_indexed | 2024-12-12T07:17:47Z |
| format | Article |
| id | doaj.art-f356e5647f824bad8a78256b9bf4195b |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-12T07:17:47Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-f356e5647f824bad8a78256b9bf4195b2022-12-22T00:33:28ZengElsevierInternational Journal of Infectious Diseases1201-97122020-10-0199338343Appropriate use of tocilizumab in COVID-19 infectionŞiran Keske0Süda Tekin1Bilgin Sait2Pelin İrkören3Mahir Kapmaz4Cansu Çimen5Semra Uğur6İrfan Çelebi7Veli Oğuzalp Bakır8Erhan Palaoğlu9Evren Şentürk10Benan Çağlayan11Nahit Çakar12Levent Tabak13Önder Ergönül14American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, TurkeyKoç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, TurkeyAmerican Hospital, Department of Internal Medicine, Istanbul, TurkeyKoç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, TurkeyKoç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, TurkeyAmerican Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, TurkeyKoç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, TurkeyAmerican Hospital, Department of Radiology and Beykent University School of Medicine, TurkeyKoç University, College of Engineering, Department of Industrial Engineering, Istanbul, TurkeyAmerican Hospital, Clinical Laboratory, Istanbul, TurkeyKoç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, TurkeyKoç University, School of Medicine, Department of Chest Diseases, Istanbul, TurkeyKoç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, TurkeyKoç University, School of Medicine, Department of Chest Diseases, Istanbul, TurkeyKoç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey; Corresponding author.Objective: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. Results: Forty-three patients were included: 70% were male; the median age was 64 years (minimum–maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. Conclusion: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.http://www.sciencedirect.com/science/article/pii/S1201971220305804TocilizumabCOVID-19CytokinesInterleukin-6Therapy |
| spellingShingle | Şiran Keske Süda Tekin Bilgin Sait Pelin İrkören Mahir Kapmaz Cansu Çimen Semra Uğur İrfan Çelebi Veli Oğuzalp Bakır Erhan Palaoğlu Evren Şentürk Benan Çağlayan Nahit Çakar Levent Tabak Önder Ergönül Appropriate use of tocilizumab in COVID-19 infection International Journal of Infectious Diseases Tocilizumab COVID-19 Cytokines Interleukin-6 Therapy |
| title | Appropriate use of tocilizumab in COVID-19 infection |
| title_full | Appropriate use of tocilizumab in COVID-19 infection |
| title_fullStr | Appropriate use of tocilizumab in COVID-19 infection |
| title_full_unstemmed | Appropriate use of tocilizumab in COVID-19 infection |
| title_short | Appropriate use of tocilizumab in COVID-19 infection |
| title_sort | appropriate use of tocilizumab in covid 19 infection |
| topic | Tocilizumab COVID-19 Cytokines Interleukin-6 Therapy |
| url | http://www.sciencedirect.com/science/article/pii/S1201971220305804 |
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