The COVID-19 global pandemic has resulted in more than 118 million cases and more than 2.5 million deaths. Most fatalities are related to severe pulmonary disease caused by a severe inflammatory response to the virus in the lungs. As yet there is no uniformly successful therapeutic agent. Tocilizumab is a monoclonal antibody that binds to IL-6 receptor thus inhibiting IL-6 mediated signaling of the inflammatory cascade. Early trials did not show a mortality benefit in patients treated with this agent. Newer studies have shown a benefit when Tocilizumab is used in conjunction with corticosteroids. This is a brief report on 7 patients with severe COVID-19 infection who received Tocilizumab therapy at our community hospital in the early period of the pandemic.
A protocol for the use of Tocilizumab in patients with severe COVID-19 infection was established by the division of Infectious Diseases. Pretreatment laboratory tests included IL-6, ferritin, CRP. Patients received one intravenous infusion of 4 to 8 mg/kg (maximum dose 800 mg). The response in 7 consecutive patients who received Tocilizumab was evaluated.
Two out of the 7 patients had good outcomes. Five patients had complicated hospital courses, 2 of them died (mortality 28.5%). IL-6 levels were elevated at baseline and there was a marked increase following the dose.
Tocilizumab benefitted two previously healthy young male patients with severe COVID-19 infection who received the dose early in the disease. Benefit was not seen in five older individuals with advanced disease. Our experience adds to the accumulating data regarding the limited benefit of single dose Tocilizumab in patients with advanced COVID-19 disease. The dose and optimal time of administration of Tocilizumab, as well as benefits when employed along with other agents like corticosteroids, remdesivir and convalescent plasma needs to be evaluated further.