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Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6

2021; Multidisciplinary Digital Publishing Institute; Volume: 10; Issue: 8 Linguagem: Inglês

10.3390/jcm10081583

2077-0383

Robert Flisiak, Jerzy Jaroszewicz, Magdalena Rogalska, Tadeusz Wojciech Łapiński, Aleksandra Berkan‐Kawińska, Beata Bolewska, Magdalena Tudrujek‐Zdunek, Dorota Kozielewicz, Marta Rorat, Piotr Leszczyński, Kajetan Klos, Justyna D. Kowalska, Paweł Pabjan, Anna Piekarska, Iwona Mozer‐Lisewska, Krzysztof Tomasiewicz, Małgorzata Pawłowska, Krzysztof Simon, Joanna Polańska, Dorota Zarębska‐Michaluk,

SARS-CoV-2 and COVID-19 Research

Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08–0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.