Higher levels of IL‐6 early after tocilizumab distinguish survivors from nonsurvivors in COVID‐19 pneumonia: A possible indication for deeper targeting of IL‐6
Open Access
- 9 June 2020
- journal article
- research article
- Published by Wiley in Journal of Medical Virology
- Vol. 92 (11), 2852-2856
- https://doi.org/10.1002/jmv.26149
Abstract
Introduction The most serious COVID‐19 deriving from severe acute respiratory syndrome coronavirus 2 causes a cytokine release storm and it is associated with worse outcomes. In COVID‐19 patients, interleukin‐6 (IL‐6) levels are significantly elevated. Blocking IL‐6 preliminarily resulted in the improvement of this hyperinflammatory state. It is unknown which patients could require higher doses of tocilizumab to get out of the cytokine storm. Materials and Methods Twenty‐four patients affected by COVID‐19 pneumonia were included. All the patients underwent tocilizumab 8 mg/kg intravenously and were tested for serum IL‐6 24 to 48 hours before and 12 to 48 hours after tocilizumab infusion. Comparisons between survivors and nonsurvivors were performed. Results Eighteen patients were discharged, while six patients died, with no clinical or laboratory differences between the two groups at baseline. IL‐6 was not different at baseline (P = .41), while 24 to 48 hours post‐tocilizumab IL‐6 serum levels were significantly higher in nonsurvivors than in survivors (2398.5 [430.5‐9372] vs 290.5 [58.5‐1305.5] pg/mL, P = .022). Serum IL‐6 post‐tocilizumab showed a good predictive ability to discriminate survivors from nonsurvivors (area under the curve, 0.815; 95% confidence interval, 0.63‐0.99, P = .02). Conclusion Repeated measurement of the serum level of IL‐6 early after tocilizumab may distinguish nonsurvivors from survivors and support the choice of deeper targeting IL‐6 in COVID‐19 pneumonia.This publication has 19 references indexed in Scilit:
- The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like DiseaseAutoimmunity Reviews, 2020
- Tocilizumab treatment in COVID‐19: A single center experienceJournal of Medical Virology, 2020
- COVID-19: consider cytokine storm syndromes and immunosuppressionThe Lancet, 2020
- Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe Lancet, 2020
- Pembrolizumab monotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase II KEYNOTE-086 studyAnnals of Oncology, 2019
- Current approaches in the grading and management of cytokine release syndrome after chimeric antigen receptor T-cell therapyTherapeutics and Clinical Risk Management, 2019
- Comparison of the clinical characteristics and severity of community-acquired pneumonia between patients with rheumatoid arthritis treated with tocilizumab and those treated with TNF inhibitorModern Rheumatology, 2018
- SAT0392 The relevance of serum procalcitonin quantification for differential diagnosis of infections and rheumatic diseasesAnnals Of The Rheumatic Diseases, 2018
- Proinflammatory Cytokines, Aging, and Age-Related DiseasesJournal of the American Medical Directors Association, 2013
- 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 diseaseBlood, 2008