IAI SPECIAL EDITION: Tocilizumab therapy in COVID-19 patients

Authors

  • Yulistiani Universitas Airlangga, Surabaya, Indonesia
  • Humaira Izka A Universitas Airlangga, Surabaya, Indonesia
  • Mareta Rindang A Universitas Airlangga, Surabaya, Indonesia
  • Prastuti A W Airlangga University Teaching Hospital, Surabaya, Indonesia

DOI:

https://doi.org/10.46542/pe.2022.222.259262

Keywords:

COVID-19, Cytokine storms, Interleukin-6, Tocilizumab

Abstract

A severe pneumonia-associated respiratory syndrome caused by the new coronavirus 2 (SARS‑CoV‑2) was identified in December 2019 as Coronavirus Disease 2019 (COVID-19). It has spread rapidly and has become a worldwide health challenge. Some patients experienced severe complications, including acute respiratory distress syndrome (ARDS), and have even progressed to an intensive care unit (ICU) admission and death. Research has reported that pathogenic T cells and inflammatory monocytes prompt an inflammatory storm with large amounts of interleukin 6. Consequently, IL-6 receptor inhibitors have been repurposed to treat COVID-19, but their exact role in treatment remains unclear. Tocilizumab (TCZ), a monoclonal antibody against IL-6, emerged as an alternative treatment in COVID-19 patients with ARDS syndrome. Therefore, the authors hypothesise that tocilizumab might be effective in decreasing the inflammatory storm and reducing mortality in COVID-19 severe cases. This observational retrospective study explored the use of a single dose of tocilizumab 400 mg intravenous infusion for an hour in COVID-19 patients.  The results showed that tocilizumab could not improve the parameters related to mortality rates,  such as IL-6 levels, leukocytes, C-reactive protein (CRP), Neutrophil-to-lymphocyte ratio (NLR), and ferritin. IL-6 levels increased after tocilizumab administration.

Author Biographies

Yulistiani, Universitas Airlangga, Surabaya, Indonesia

Faculty of Pharmacy

Humaira Izka A, Universitas Airlangga, Surabaya, Indonesia

Faculty of Pharmacy

Mareta Rindang A, Universitas Airlangga, Surabaya, Indonesia

Faculty of Pharmacy

References

Bhaskar, S., Sinha, A., Banach, M., Mittoo, S., Weissert, R., Kass, J. S., Rajagopal, S., Pai, A. R., & Kutty, S. (2020). Cytokine Storm in COVID-19—Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Frontiers in Immunology, 11, 1–16. https://doi.org/10.3389/fimmu.2020.01648

Cortegiani, A., Ippolito, M., Greco, M., Granone, V., Protti, A., Gregoretti, C., Giarratano, A., Einav, S., & Cecconi, M. (2021). Rationale and Evidence on the use of Tocilizumab in COVID-19: a systematic review. Pulmonology, 27, 52–66. https://doi.org/https://doi.org/10.1016/j.pulmoe.2020.07.003

Fajgenbaum, D.C., & June, C.H. (2020). Cytokine Storm. New England Journal of Medicine, 383(23), 2255–2273. https://doi.org/10.1056/nejmra2026131

Kim, J.S., Lee, J.Y., Yang, J.W., Lee, K.H., Effenberger, M., Szpirt, W., Kronbichler, A., & Shin, J. Il. (2020). Immunopathogenesis and treatment of cytokine storm in COVID-19. Theranostics, 11(1), 316–329. https://doi.org/10.7150/thno.49713

Kukar, M., Petryna, O., & Efthimiou, P. (2009). Biological targets in the treatment of rheumatoid arthritis: A comprehensive review of current and in-development biological disease modifying anti-rheumatic drugs. Biologics: Targets and Therapy, 3, 443–457. https://doi.org/10.2147/BTT.S6640

Luo, P., Liu, Y., Qiu, L., Liu, X., Liu, D., & Li, J. (2020). Tocilizumab treatment in COVID-19: A single center experience. Journal of Medical Virology, 92(7), 814–818. https://doi.org/10.1002/jmv.25801

Mortaz, E., Tabarsi, P., Varahram, M., Folkerts, G., & Adcock, I. M. (2020). The Immune Response and Immunopathology of COVID-19. Frontiers in Immunology, 11, 1–9. https://doi.org/10.3389/fimmu.2020.02037

Nishimoto, N., & Mima, T. (2009). Tocilizumab. Rheumatoid Arthritis, 367–371. https://doi.org/10.1016/B978-032305475-1.50050-1

Nishimoto, N., Terao, K., Mima, T., Nakahara, H., Takagi, N., & Kakehi, T. (2008). Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood, 112(10), 3959–3964. https://doi.org/10.1182/blood-2008-05-155846

Oldfield, V., Dhillon, S., & Plosker, G. L. (2009). Tocilizumab a review of its use in the management of rheumatoid arthritis. Drugs, 69(5), 609–632. https://doi.org/10.2165/00003495-200969050-00007

PDPI, PERKI, PAPDI, PERDATIN, IDAI. (2020). Pedoman Tata Laksana Pasien COVID-19. Edisi 3, p. 23-102

Stone, J.H., Frigault, M.J., Serling-Boyd, N.J., Fernandes, A. D., Harvey, L., Foulkes, A.S., Horick, N.K., Healy, B.C., Shah, R., Bensaci, A.M., Woolley, A.E., Nikiforow, S., Lin, N., Sagar, M., Schrager, H., Huckins, D.S., Axelrod, M., Pincus, M.D., Fleisher, J., J., Sacks, C., Dougan, M., North, C., Halvorsen, Y., Thurber, T., Dagher, Z., Scherer, A., Wallwork, R. S., Kim, A. Y., Schoenfeld, S., Sen, P., Neilan, T., Perugino, C., Unizony, D., Collier, D., Matza, M., Yinh, J., Bowman, K., Meyerowitz, E., Zafar, A., Drobni, Z., Bolster, M., Kohler, M., D’Silva, K., Dau, J., Lockwood, M., Cubbison, C., Weber, B., Mansour, M. K. (2020). Efficacy of Tocilizumab in Patients Hospitalized with Covid-19. New England Journal of Medicine, 2333–2344. https://doi.org/10.1056/nejmoa2028836

Tanaka, T., Ogata, A., & Narazaki, M. (2013). Tocilizumab: An updated review of its use in the treatment of rheumatoid arthritis and its application for other immune-Mediated diseases Clinical Medicine Insights: Therapeutics, 5, 33–52. https://doi.org/10.4137/CMT.S9282

Xu, X., Han, M., Li, T., Sun, W., Wang, D., Fu, B., Zhou, Y., Zheng, X., Yang, Y., Li, X., Zhang, X., Pan, A., & Wei, H. (2020). Effective treatment of severe COVID-19 patients with tocilizumab. Proceedings of the National Academy of Sciences of the United States of America, 117(20), 10970–10975. https://doi.org/10.1073/pnas.2005615117

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Published

2022-03-31

How to Cite

Yulistiani, Izka A, H., Rindang A, M., & A W, P. (2022). IAI SPECIAL EDITION: Tocilizumab therapy in COVID-19 patients. Pharmacy Education, 22(2), p. 259–262. https://doi.org/10.46542/pe.2022.222.259262

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Section

Special Edition