Abstract
Background: Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug-related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID-19 patients.
Methods: All adult inpatients with COVID-19 between 1 March and 25 April 2020 that received TCZ were included. We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions.
Results: Seventy-four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (P = .013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, P = .03).
Conclusion: Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use.
Keywords: Il-6 inhibition; SARS coronavirus; coronavirus; cytokine/chemokine; immune responses; tocilizumab.
【저자키워드】 coronavirus, Tocilizumab, immune responses, SARS Coronavirus, IL-6 inhibition, cytokine/chemokine, 【초록키워드】 COVID-19, Efficacy, clinical trial, intensive care, mechanical ventilation, Tocilizumab, Pneumonia, IL-6, Infection, Toxicity, cytokine, hypertension, chemokine, immune, Cytokine release syndrome, immune responses, management, Patient, liver function tests, Complication, mortality rate, incidence, SARS Coronavirus, concern, Admission, COVID-19 patients, IL-6 inhibition, Bacterial, neutropenia, intensive care unit admission, CRS, infusion, Allergic reactions, risk of infection, 48 hours, Liver function test, Inpatient, Reactions, control group, toxicities, Elevation, while, MOST, diverticulitis, greater, evaluate, occurred, significantly more, evaluated, elevated, receiving, TCZ, weighed, with COVID-19, 【제목키워드】 COVID-19, Tocilizumab, management, infectious complication,