key: cord-1017577-y411u6d2
authors: Hassoun, Ali; Thottacherry, Elizabeth Dilip; Muklewicz, Justin; Aziz, Quarrat-ul-ain; Edwards, Jonathan
title: Utilizing tocilizumab for the treatment of cytokine release syndrome in COVID-19
date: 2020-05-16
journal: J Clin Virol
DOI: 10.1016/j.jcv.2020.104443
sha: b89ec1ad21bcf8818f69c7e5c679fe3e793f28de
doc_id: 1017577
cord_uid: y411u6d2

nan

We present 9 patients with confirmed COVID-19 by detection of SARS-CoV 2 via reverse-transcriptase polymerase chain reaction in two community hospitals treated with tocilizumab. The criteria for tocilizumab use (Table 2 ) was based on publicized clinical trial protocols and the package insert and was tailored to our needs.[3] Mean age was 60 years (37 -88 years). Mean body mass index was 29.9 kg/m2 (17.8 -38 kg/m2). All patients presented 7 to 10 days after symptom onset except Patient 4 who was transferred into our facility. All patients except one were admitted or transferred to the Intensive Care Unit (ICU). Average length of ICU stay was 10 days with 5 patients requiring ventilation. A lower subcutaneous dose of tocilizumab was given to 3 patients. Death occurred in 2 patients. Patient 7 underwent cardiac arrest after tocilizumab therapy, making it impossible to interpret the effect of tocilizumab. Clinical improvement was observed in 7 of the remaining 8 patients with either decreasing oxygen requirements or successful extubation. Most patients noted an improvement in inflammatory markers 

Corticosteroids were administered with tocilizumab in 3 patients and have been used in prior studies for its potential steroid sparing effect. [5] There are concerns regarding the risk of infection as well as theoretically delaying viral clearance.[2, 5] Our patients were screened for infections prior to and after treatment. In our evaluation, three patients were treated with antibiotic therapy for presumed hospital acquired pneumonia at various points throughout their hospital stay. Viral clearance was not assessed in our patients.

To conclude, while administration of tocilizumab in patients with COVID-19 exhibiting signs of CRS appeared to show clinical improvement, the ideal setting and dose of administration requires further study.

The authors report no conflicts of interest. J o u r n a l P r e -p r o o f 

Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All authors contributed equally to the production of this report.