When to Start Tocilizumab in Moderate to Severe COVID 19 Patients?
Tocilizumab is a recombinant humanised monoclonal antibody of the IgG1 class, which is directed against both the soluble and membrane-bound forms of the interleukin-6 (IL-6) receptor. Studies have demonstrated a mortality benefit with tocilizumab. In a recent study, researchers reported that the ideal time to give tocilizumab is when the patient is on non-rebreather mask (NRBM) support. The study findings were published in the Journal of the Association of Physicians of India on December 01, 2021.
No therapy has been approved for COVID-19 pneumonia, but current clinical approaches consider the combination of antiviral drugs and immunomodulatory drugs. Studies have shown markedly elevated inflammatory markers (eg Neutrophil to lymphocyte ratio, Ferritin, C reactive protein, D-dimer ) and elevated proinflammatory cytokines (IL-6) are associated with poorer outcomes. Tocilizumab, an IL-6 receptor blocker, blocks the inflammatory response in cytokine storm syndrome. However, timing to give tocilizumab is important as it affects the outcome considerably. Dr Vaishnavi M Rathod and her team conducted a study to determine the effectiveness of tocilizumab as adjuvant therapy in moderate to severe covid-19 pneumonia patients.
- Among 80 patients, 35 were discharged and, 55 died.
- The researchers found that, among 35 patients who recovered, mean time to clinical improvement was average 6.9 days, mean duration of ICU stay was 13.42 days, mean ventilator-free days was 12.22 days, mean time to hospital discharge was 16.4 days.
- They observed that even after giving tocilizumab mortality was higher in patients above 60 years of age, two or more co-morbidities, SpO2 of less than 85% on the room air, SOFA scoring of more than or equal to 3, radiological involvement of more than 2 zones, higher score (>3) of inflammatory markers, higher level of the mode of respiratory support like BiPAP or invasive ventilation.
- They found no difference in outcome in patients of either gender, blood pressure and on admission blood sugar levels, and co-administration of injection Ramdesivir.
