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  • Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: a case–control study

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Letter
Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: a case–control study
  1. Nicola Potere1,2,
  2. Marcello Di Nisio3,4,
  3. Donatella Cibelli5,
  4. Rosa Scurti6,
  5. Antonella Frattari7,
  6. Ettore Porreca1,
  7. Antonio Abbate2,
  8. Giustino Parruti5
  1. 1 Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University, Chieti, Italy
  2. 2 VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3 Department of Medicine and Ageing Sciences, "G' D'Annunzio" University, Chieti-Pescara, Italy
  4. 4 Department of Vascular Medicine, Amsterdam Medical Center, Amsterdam, The Netherlands
  5. 5 Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
  6. 6 Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy
  7. 7 Intensive Care Unit, Pescara General Hospital, Pescara, Italy
  1. Correspondence to Dr Giustino Parruti, Infectious Diseases Unit, Pescara Hospital, Pescara 65124, Italy; parrutig@gmail.com

https://doi.org/10.1136/annrheumdis-2020-218243

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    Many patients with severe COVID-19 rapidly progress to critical disease with refractory hypoxemia requiring invasive mechanical ventilation (IMV).1 Elevated levels of C reactive protein (CRP) and interleukin-6 (IL-6), reflecting an hyperinflammatory response, identify patients at risk of progression to refractory hypoxemia and death.2 Recent evidences suggested that high-dose intravenous tocilizumab (TCZ), a humanised anti-IL-6 receptor antibody, may rapidly reduce fever and inflammatory markers, and improve oxygenation in severe to critical COVID-19.3–5 Data on the safety and efficacy of subcutaneous TCZ, already approved for the treatment of rheumatoid arthritis, are limited. The aim of this study was to compare the clinical course and outcomes of patients treated with subcutaneous TCZ on top of standard of care (SOC) with those of patients receiving SOC only.

    In this retrospective case–control study, we treated with TCZ 324 mg, given as two concomitant subcutaneous injections, all consecutive patients at Pescara General Hospital, Italy between 28 March and 21 April 2020, with laboratory-confirmed COVID-19 pneumonia (involving ≥20% of lung parenchyma on chest CT), hyperinflammation (CRP ≥20 mg/dL), hypoxemia (oxygen saturation <90% on room air) requiring supplemental oxygen through nasal cannulas or mask, who had no contraindications to treatment such as bacterial or fungal infection, neutropenia or liver injury. Patients signed an informed consent for the off-label use of TCZ. We reviewed all patients hospitalised …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors The corresponding author had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: NP, AA, GP. Statistical analysis: NP, AA, GP. Interpretation of the data: NP, AA, GP. Drafting of the manuscript: NP, MDN, AA. Critical revision of the manuscript for important intellectual content: all authors. Final approval of the manuscript: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MDN has received personal fees from Bayer, Daiichi Sankyo, Sanofi, Pfizer, Leo Pharma and Aspen, outside of the submitted work. AA has received research support from Novartis, Olatec and Swedish Orphan Biovitrum, outside of the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.