• Int. J. Infect. Dis. · Oct 2020

    Appropriate use of tocilizumab in COVID-19 infection.

    • Şiran Keske, Süda Tekin, Bilgin Sait, Pelin İrkören, Mahir Kapmaz, Cansu Çimen, Semra Uğur, İrfan Çelebi, Veli Oğuzalp Bakır, Erhan Palaoğlu, Evren Şentürk, Benan Çağlayan, Nahit Çakar, Levent Tabak, and Önder Ergönül.
    • American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
    • Int. J. Infect. Dis. 2020 Oct 1; 99: 338-343.

    ObjectiveThis study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations.MethodsAll patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations.ResultsForty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p <  0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p =  0.025, p =  0.002, p =  0.008, p =  0.002, and p =  0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones.ConclusionEarlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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