Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3763-3773
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3763
Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients
Jia Zeng, Ming-Hui Xie, Jing Yang, Sheng-Wu Chao, Er-Li Xu
Jia Zeng, Er-Li Xu, Department of Aviation Disease, Naval Medical Center of PLA, Shanghai 200052, China
Jia Zeng, Ming-Hui Xie, Jing Yang, Sheng-Wu Chao, No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
Ming-Hui Xie, Department of Interventional Therapy, First Affiliated Hospital, the Second Military Medical University, Shanghai 200433, China
Jing Yang, Department of Nephrology, Naval Medical Center of PLA, Shanghai 200052, China
Sheng-Wu Chao, Department of Cardiovascular Medicine, Naval Medical Center of PLA, Shanghai 200052, China
Author contributions: Zeng J and Xie MH contributed equally to this work; Zeng J and Xu El designed the research; Zeng J, Yang J and Chao SW collected and analyzed the clinical data; Zeng J, Yang J and Chao SW wrote the manuscript; Xu El revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital Institutional Review Board.
Informed consent statement: We obtained consent from the patients or their relatives for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Er-Li Xu, BMed, Associate Chief Physician, Department of Aviation Disease, Naval Medical Center of PLA, No. 338 Huaihai West Road, Changning District, Shanghai 200052, China. yijiacheng455@163.com
Received: May 8, 2020
Peer-review started: May 8, 2020
First decision: June 7, 2020
Revised: June 8, 2020
Accepted: August 6, 2020
Article in press: August 6, 2020
Published online: September 6, 2020
Processing time: 118 Days and 23.5 Hours
ARTICLE HIGHLIGHTS
Research background

The main pathophysiological basis of Coronavirus disease 2019 (COVID-19) causing respiratory failure, is the cytokine storm, and interleukin-6 (IL-6) is an important component of the COVID-19 cytokine storm. As a specific antagonist of IL-6, tocilizumab may block the cytokine storm in COVID-19.

Research motivation

The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia (7th Edition) includes tocilizumab as a recommended drug for immunotherapy in severe COVID-19 patients. However, the specific clinical efficacy of tocilizumab in the treatment of COVID-19 is worth studying.

Research objectives

This study aimed to determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19.

Research methods

In total, 19 severe and critical COVID-19 patients who were treated with tocilizumab were included in this study. The imaging manifestations and the clinical data before and after treatment were analyzed retrospectively, including routine peripheral venous blood tests, routine blood biochemical tests, coagulation test, C-reactive protein (CRP), IL-6, and arterial blood gas analysis.

Research results

Of the 19 patients in this group, 13 (68.4%) had significantly improved symptoms of COVID-19 (5 patients were discharged directly and 8 patients were transferred after improvement). One case was invalid, 1 case was exacerbated, and 4 deaths (21.1%) all critical cases were observed. The lymphocyte count, CRP, lactic acid, oxygenation index, FIB and IL-6 levels were significantly different in the improved group.

Research conclusions

Tocilizumab treatment is effective against IL-6 in COVID-19 patients, but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19. In the clinical treatment of patients, attention should be paid to the timing of drug administration and other adjuvant treatments.

Research perspectives

In this study, we found that most of the patients with COVID-19 had reduced IL-6 levels and inflammation indices following treatment with tocilizumab, however, the therapeutic effect of tocilizumab is not so good in elderly critical patients. Therefore, we should administer tocilizumab as much as possible before patients develop serious secondary complications. Otherwise, if the best opportunity of treatment is missed, the clinical effect will be limited.