• Christine A Vu, Kailynn J DeRonde, Ana D Vega, Meshell Maxam, Gregory Holt, Yoichiro Natori, Jose Gonzales Zamora, Veronica Salazar, Renata Boatwright, Stephen R Morris, Daniela de Lima Corvino, Anmary Fernandez Betances, Leah Colucci, James Keegan, Andy Lopez, Andrew Hany Rezk, Yvette Rodriguez, Gabriela M Moraru, Susanne Doblecki, David J De La Zerda, and Lilian M Abbo.
• Department of Pharmacy, Jackson Health System, Miami, FL, USA. christine.vu@jhsmiami.org.
• Bmc Infect Dis. 2020 Dec 22; 20 (1): 964.

BackgroundDue to the lack of proven therapies, we evaluated the effects of early administration of tocilizumab for COVID-19. By inhibition of the IL-6 receptor, tocilizumab may help to mitigate the hyperinflammatory response associated with progressive respiratory failure from SARS-CoV-2.MethodsA retrospective, observational study was conducted on hospitalized adults who received intravenous tocilizumab for COVID-19 between March 23, 2020 and April 10, 2020.ResultsMost patients were male (66.7%), Hispanic (63.3%) or Black (23.3%), with a median age of 54 years. Tocilizumab was administered at a median of 8 days (range 1-21) after initial symptoms and 2 days (range 0-12) after hospital admission. Within 30 days from receiving tocilizumab, 36 patients (60.0%) demonstrated clinical improvement, 9 (15.0%) died, 33 (55.0%) were discharged alive, and 18 (30.0%) remained hospitalized. Successful extubation occurred in 13 out of 29 patients (44.8%). Infectious complications occurred in 16 patients (26.7%) at a median of 10.5 days. After tocilizumab was administered, there was a slight increase in PaO2/FiO2 and an initial reduction in CRP, but this effect was not sustained beyond day 10.ConclusionsMajority of patients demonstrated clinical improvement and were successfully discharged alive from the hospital after receiving tocilizumab. We observed a rebound effect with CRP, which may suggest the need for higher or subsequent doses to adequately manage cytokine storm. Based on our findings, we believe that tocilizumab may have a role in the early treatment of COVID-19, however larger randomized controlled studies are needed to confirm this.

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