Tocilizumab potential for COVID-19 suggested
medwireNews: The interleukin (IL)-6 inhibitor tocilizumab may be an option for the treatment of COVID-19, suggests a case report of a patient with cancer and comorbid severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
The study authors explain that the pathogenesis of COVID-19 “involves a cytokine storm with high serum levels of pro-inflammatory cytokines and chemokines,” with IL-6 having “a prominent role.”
Therefore, “IL-6 may be a potential actionable target cytokine to treat Covid-19-related acute respiratory distress syndrome,” they write in a letter published in the Annals of Oncology.
The team reports on a 42-year-old man with metastatic kidney cancer who had “a rapid favorable outcome” to the IL-6 inhibitor tocilizumab, which is currently indicated for the treatment of rheumatoid arthritis, giant cell arteritis, and juvenile idiopathic arthritis, as well as for cytokine release syndromes induced by chimeric antigen receptor T-cell therapies.
The patient was hospitalized on 12 March 2020 for fever and bone metastasis pain, following which he developed a mild cough on day 6. Laboratory testing for SARS-CoV-2 confirmed the presence of the virus and a computed tomography scan showed bilateral ground glass opacities.
A 5-day course of the antiviral lopinavir–ritonavir was initiated, but the patient’s condition deteriorated on day 8 and he was given two infusions – 8 hours apart – of tocilizumab at a dose of 8 mg/kg. The patient’s condition improved thereafter, both clinically (eg, no fever) and in terms of other markers, such as the partial resolution of ground glass appearance on imaging.
Highlighting the recent negative clinical trial of lopinavir–ritonavir in patients with severe COVID-19, Jean-Marie Michot and co-authors (all from Université Paris-Saclay in Villejuif, France) write: “It thus seems likely that the rapid control of the pulmonary hyperinflammation resulted from tocilizumab treatment.”
They believe that this “promising therapy” for COVID-19 should be “studied urgently,” but caution that the experience of this patient may not be generalizable to people without cancer.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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