key: cord-340314-5oz3013n
authors: Mazzitelli, Maria; Arrighi, Eugenio; Serapide, Francesca; Pelle, Maria Chiara; Tassone, Bruno; Lionello, Rosaria; Marrazzo, Giuseppina; Laganà, Domenico; Costanzo, Francesco Saverio; Matera, Giovanni; Trecarichi, Enrico Maria; Torti, Carlo
title: Use of subcutaneous tocilizumab in patients with COVID‐19 pneumonia
date: 2020-05-15
journal: J Med Virol
DOI: 10.1002/jmv.26016
sha: 
doc_id: 340314
cord_uid: 5oz3013n

Over the last months, pandemic SARS‐CoV‐2 caused a significant challenge for clinicians. Unfortunately, no approved and validated treatments are available. Intravenous tocilizumab, an antirheumatic drug, seems to be promising in counteracting cytokine storm caused by SARS‐CoV‐2 infection with associated clinical improvements. We report herein a case series of patients with COVID‐19 pneumonia who were treated with tocilizumab administrated, for the first time, subcutaneously with good clinical and radiological outcomes. This article is protected by copyright. All rights reserved.

(TCZ) in treating severe coronavirus disease 2019 . 1 This adds to several data emerging from case reports and uncontrolled studies. [2] [3] [4] [5] However, to the best of our knowledge data on subcutaneous (SC) use of TCZ are lacking. We have treated three patients with this drug at a single dose of 162 mg given subcutaneously, in line with data showing similar efficacy compared to This article is protected by copyright. All rights reserved.

intravenously given TCZ for different diseases. 6 Treatment course for these patients is described below.

The first patient was a 61 year-old woman who had only hypercholesterolemia in her past medical history. She was admitted to our hospital on March 31 st , 2020, with cough, fever and shortness of breath. She was already on treatment with azithromycin, lopinavir/ritonavir, and hydroxychloroquine from March 28 th, 2020.

Oxygen was administered with high flow nasal cannula at 60 L/min with FiO2=75%.

An antibiotic coverage for pneumonia with piperacillin/tazobactam was added. For persistence of dyspnoea and on the basis of radiologic findings and IL-6 serum level (106.1 pg/mL), SC TCZ was administered on April 1 st , 2020. No major adverse events were reported apart from mild increase of liver function tests two days following SC tocilizumab (ALT 201 UI/l; AST 108 UI/l), with subsequent rapid normalization. Fever disappeared two days after and oxygen support was progressively decreased and stopped twelve days after TCZ administration.

Significant reduction of IL-6 was observed in one week (from 106.1 pg/ml to 6.32 pg/mL) with a clear improvement of radiological findings at high-resolution computerized tomography (HRCT) from April 1 st to April 18 th , 2020 (see Figure 1 , panel 1A and 1B, respectively).

The second patient was a 57 year-old woman who suffered from hypertension, diabetes, obesity, and depression. She was admitted on March 29 th with fever, cough, tachypnoea, and occasional shortness of breath. Antiviral treatment with hydroxychloroquine and azithromycin was started. The day after admission, nasal flow oxygen therapy was prescribed (2 L/min), followed by Venturi mask (at 15 L/min, FiO2=60%,) for worsening of SpO2 from 98% to 94%. Plasma concentration of IL-6 was 72.65 pg/mL after three days from admission, with worsening of

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We want to thank all our patients and our nurses. We also thank the Infectious