Compassionate Use of Tocilizumab for Treatment of SARS-CoV-2 Pneumonia

作者：Stanley C. Jordan, Phillip C. Zakowski, Hai Phuong Nguyen Tran, Ethan A. Smith, C Gaultier, Gregory Marks, Rachel Zabner, Hayden Lowenstein, Jillian Oft, Benjamin Ephraim Bluen, Catherine N. Le, Rita R. Shane, Noriko Ammerman, Ashley A. Vo, Peter Chen, Sanjeev Kumar, Mieko Toyoda, Shili Ge, Edmund Huang · 发表于：Clinical Infectious Diseases · 年份：2020 · DOI：10.1093/cid/ciaa812 · 被引用次数：89 · 研究领域：COVID-19 Clinical Research Studies、SARS-CoV-2 and COVID-19 Research、Long-Term Effects of COVID-19

BACKGROUND: Preliminary data from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patients indicate that a cytokine storm may increase morbidity and mortality. Tocilizumab (anti-IL-6R) is approved by the Food and Drug Administration for treatment of cytokine storm associated with chimeric antigen receptor T-cell therapy. Here we examined compassionate use of tocilizumab in patients with SARS-CoV-2 pneumonia. METHODS: We report on a single-center study of tocilizumab in hospitalized patients with SARS-CoV-2 pneumonia. All patients had confirmed SARS-CoV-2 pneumonia and oxygen saturations <90% on oxygen support with most intubated. We examined clinical and laboratory parameters including oxygen and vasopressor requirements, cytokine profiles, and C-reactive protein (CRP) levels pre- and post-tocilizumab treatment. RESULTS: Twenty-seven SARS-CoV-2 pneumonia patients received one 400 mg dose of tocilizumab. Interleukin (IL)-6 was the predominant cytokine detected at tocilizumab treatment. Significant reductions in temperature and CRP were seen post-tocilizumab. However, 4 patients did not show rapid CRP declines, of whom 3 had poorer outcomes. Oxygen and vasopressor requirements diminished over the first week post-tocilizumab. Twenty-two patients required mechanical ventilation; at last follow-up, 16 were extubated. Adverse events and serious adverse events were minimal, but 2 deaths (7.4%) occurred that were felt unrelated to tocilizumab. CONCLUSIONS: Comp...