The effectiveness of Covid-19 complex therapy with tocilizumab
https://doi.org/10.51922/1818-426X.2023.3.45
Abstract
Cytokine release syndrome with increased levels of interleukin-6 (IL-6) is associated with multiple organ damage and death in severe coronavirus disease. Trials to investigate the efficacy of IL-6 inhibitors, namely Tocilizumab, are ongoing with promising but conflicting results.
Objective. To identify the effectiveness of complex therapy for COVID-19 with the appointment of the drug Tocilizumab.
Material and methods. In order to identify the effectiveness and criteria for prescribing targeted therapy using Tocilizumab, a statistical analysis of clinical and laboratory parameters was performed in patients with severe and moderate COVID-19, in the group of patients treated with the drug (n = 174) and the group of patients receiving standard therapy (without Tocilizumab therapy) (n = 70). The comparison groups were similar in terms of gender and age characteristics.
The effectiveness of targeted therapy with the use of tocilizumab was assessed in terms of general and biochemical blood tests, levels of procalcitonin, IL-6 and presepsin, and outcomes among patients.
Results. The average values of the analyzed values (concentration of leukocytes, neutrophils p/n, AST, CPK-MB, LDH, creatinine, urea, IL-6, P-SEP before therapy were variably higher or lower than normal in patients of both analyzed groups and had statistically significant differences when compared between groups (p < 0.05). The concentrations of erythrocytes, hemoglobin, hematocrit, platelets, lymphocytes, ALT, albumin, CPK, total protein, CRP, ferritin and PCT did not have statistically significant differences between the groups before the appointment of therapy.
All analyzed parameters showed a variable change in the end point of control, depending on the improvement of the patient’s condition or death. At the same time, the stabilization of leukocytes, neutrophils p/I, ALT, AST, CPK-MB, creatinine, CPK, ferritin, PCT, IL-6 and P-SEP in the tocilizumab therapy group was noted compared with the baseline and indicators of the comparison group.
The expected survival rate for therapy with tocilizumab was 2.5 times higher than for therapy without Tocilizumab.
Conclusion. After the use of Tocilizumab in patients of group 1, the level of CRP concentration significantly decreased (by 46.7 mg/l – 63 %), ferritin (by 366.9 µg/l – 84 %), PCT (by 0.122 ng/ml – 76 %), IL-6 (by 51.2 pg/ml – 93 %), P-SEP (by 225 pg/ml – 67 %), (by 4.1 U/l – 9 %), AST (by 34.5 U/l – 56 %), CPK (by 121 U/l – 57 %).
About the Authors
O. P. Selitskaya
УО «Белорусский государственный медицинский университет»
Belarus
Belarus
M. L. Docenko
УО «Белорусский государственный медицинский университет»
Belarus
Belarus
S. S. Gratchev
УО «Белорусский государственный медицинский университет»
Belarus
Belarus
References
1. Wiersinga, W. J., Rhodes A., Cheng A. C. et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): a review // JAMA. – 2020. – Vol. 324, № 8. – P. 782–793.
2. Tay, M. Z., Poh C. M., Rénia L. et al. The trinity of COVID-19: immunity, inflammation and intervention // Nat. Rev. Immunol. – 2020. – Vol. 20, № 6. – P. 363–374.
3. Chen, G., Wu D., Guo W. et al. Clinical and immunological features of severe and moderate coronavirus disease 2019 // The J. of Clin. Invest. – 2020. – Vol. 130, № 5. – P. 2620–2629.
4. Qin, C., Zhou L., Hu Z. et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China // Clin. Infect. Dis. – 2020. – Vol. 71, № 15. – P. 762–768.
5. Chen, X., Zhao B., Qu Y. et al. Detectable serum severe acute respiratory syndrome Coronavirus 2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 level in critically ill patients with Coronavirus Disease 2019 // Clin. Infect. Dis. – 2020. – Vol. 71, № 8. – P. 1937–1942.
6. Chen, X., Zhao B., Qu Y. et al. Detectable serum severe acute respiratory syndrome Coronavirus 2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 level in critically ill patients with Coronavirus Disease 2019 // Clin. Infect. Dis. – 2020. – Vol. 71, № 8. – P. 1937–1942.
7. Del Valle, D. M., Kim-Schulze S., Huang H. H. et al. An inflammatory cytokine signature predicts COVID-19 severity and survival // Nat. Med. – 2020. – Vol. 26, № 10. – P. 1636–1643.
8. Suhomlinova, I. M. Tocilizumab, baricitinib, olokizumab i deksametazon: sravnitel’naja harakteristika i prognoz jeffektivnosti pri COVID-19 / I. M. Suhomlinova, I. G. Bakulin, M. Ju. Kabanov // Terapija. – 2022. – T. 8, № 7. – S. 110–116.
9. Roche FDA approves Roche’s Actemra/RoActemra (tocilizumab) for the treatment of CAR T cell-induced cytokine release syndrome [Electronic resource]. – Mode of access: https://www.roche.com/media/releases/medcor-2017-08-30.htm. – Date of access: 02.05.2023.
10. Buonaguro, F. M., Puzanov I., Ascierto P. A. Anti-IL6R role in treatment of COVID-19-related ARDS // J. of Transl. Med. – 2020. – Vol. 18, № 1. – P. 165.
11. Terehova, V. Ju. Primenenie tocilizumaba u pacientov s COVID-19 / V. Ju. Terehova // Tribuna uchenogo. – 2021. – № 4. – S. 408–411.
12. Nasonov, E. L. Koronavirusnaja bolezn’-2019 (COVID-19): znachenie ingibitorov IL-6 / E. L. Nasonov // Pul’monologija. – 2020. – T. 30, № 5. – S. 629–644.
13. Praktika primenenija tocilizumaba u pacientov s COVID-19 (rezul’taty retrospektivnogo monitoringa) / L. N. Gavrilenko, I. N. Kozhanova, I. S. Romanova [et al.] // Recept. – 2021. – T. 24, № 6. – S. 773–783.
14. Ortenberg, Je. A. SOVID-19 i tocilizumab – klinikojekonomicheskie paralleli (obzor literatury) / Je. A. Ortenberg // Universitetskaja medicina Urala. – 2021. – T. 7, № 4. – S. 69–72.
15. Stone, J. H., Frigault M. J., Serling-Boyd N. J. et al. Efficacy of tocilizumab in patients hospitalized with Covid-19 // The N. Engl. J. of Med. – 2020. – Vol. 383, № 24. – P. 2333–2344.
16. Primenenie raznyh form tocilizumaba v lechenii pacientov so srednetjazhelym i tjazhelym techeniem COVID-19 / E. I. Veselova, G. D. Kaminskij, O. V. Lovacheva [et al.] // Tuberkulez i bolezni legkih. – 2021. – T. 99, № 1. – S. 7–14.
17. Cortegiani, A., Ippolito M., Greco M. et al. Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review // Pulmonology. – 2021. – Vol. 27, № 1. – P. 52–66.
18. Citokinovyj shtorm pri koronavirusnoj infekcii COVID-19: opyt ispol’zovanija preparata tocilizumab / Je. A. Docenko, M. V. Sholkova, I. Ja. Gucaljuk [et al.] // Recept. – 2021. – T. 24, № 4. – S. 434–444.
Review
For citations:
Selitskaya O.P., Docenko M.L., Gratchev S.S. The effectiveness of Covid-19 complex therapy with tocilizumab. Medical Journal. 2023;(3):45-52. (In Russ.) https://doi.org/10.51922/1818-426X.2023.3.45
Views:
10
Email this article 