Assessment of therapeutic response of the Tocilizumab in SARS-CoV-2 associated cytokine storm: A single center experience
Keywords:Cytokine release syndrome (CRS), Interleukin-6 (IL-6), Tocilizumab (TCZ), Critically Ill
Background: Critical COVID-19 patients may present with a cytokine storm-like phenomenon. IL-6 is found to be a key player in this cytokine storm, and COVID-19 severity is directly linked to the IL-6 levels.
Objective: To assess the response of Tocilizumab during the inflammatory phase of COVID-19 patients.
Methodology: This cross-sectional study was based on a retrospective collection of data from the records of a total of 17 COVID patients, admitted to the COVID Unit of Farooq Hospital, Lahore, from 1st October 2020 to 30th December 2020. The ethical review board of Akhtar Saeed Medical and Dental College, Lahore approved the research. All these patients received 8mg/kg of body weight Tocilizumab intravenously for pneumonia in COVID-19 patients. All these patients were evaluated for IL-6 levels in serum initially for 2-3 days (24-48 hours) before and after the 3rd day and 7th day of Tocilizumab infusion. The Electrochemiluminescence immunoassay method was used to quantify serum IL-6. The SPSS (v. 22.0) was used for analysis.
Results: The analysis shows that the median (IQR) IL-6 levels prior to treatment with Actemra, three days after Actemra administration, and seven days after Actemra was administered, were 1879 (IQR=726-2842), 1136 (IQR=499-2266), and 438 (IQR=151-1085), respectively. The change in Il-6 levels before and after Actemra administration was statistically significant, (p=0.001). A notable difference was also observed between IL-6 levels with respect to Actemra administration after three and seven days (p=0.04). There was a statistically significant median difference in IL-6 levels seven days post-Actemra in patients who survived and died, (P=0.01).
Conclusion: Tocilizumab administration along with sequential laboratory investigations particularly IL6 might be helpful in reducing the complications of cytokine storm in patients with severe COVID-19 pneumonia, resulting in better outcomes.