key: cord-0815884-zegearxa authors: Madenidou, Anastasia-Vasiliki; Bukhari, Marwan title: Real-life experience of tocilizumab use in COVID-19 patients date: 2020-06-17 journal: Rheumatology (Oxford) DOI: 10.1093/rheumatology/keaa325 sha: a778dea6faba97f404b45c0b47aa41693b79ca6c doc_id: 815884 cord_uid: zegearxa nan the majority of patients (42.4%) had one dose of 8 mg/ kg or 400 mg intravenously. Patients also received other experimental treatments, such as antiviral therapy [4] [5] [6] [11] [12] [13] and hydroxychloroquine [3, 5, 6, [8] [9] [10] . Thirtyone (34%) patients also received methylprednisolone [1, 4, 10, 12] . Outcome measures, laboratory parameters and adverse events after tocilizumab treatment are presented in Table 1 . The patient progress results are available for 76 out of 92 patients. A total of 44/76 (57.9%) patients improved and 31/76 (40.8%) were discharged from the hospital. Furthermore, 13/76 (17.1%) patients remained stable or with moderate disease. Nine out of 76 (11.8%) patients died, eight (10.5%) patients remain in critical condition [2, 3, 9] and two (2.6%) patients got worse. Initial improvement was noticed in 25/76 (32.9%) patients within the first 24 h with reduction or even normalization of temperature [4, 7, 8, 10, 11] . CRP decreased in accordance with the clinical improvement and even normalized after a median of 5 days [1, 4, 5, 11, 12] . Based on the IL-6 levels of 17/92 (18.5%) patients, IL-6 spiked shortly after the tocilizumab administration and then decreased, but continued to increase in four patients that died or deteriorated [1, 10, 12] . The temporary increase in IL-6 serum levels is probably explained by the unavailability of IL-6 receptor which is blocked by the tocilizumab. A total of 3/44 (6.8%) patients with clinical improvement also had repeat CT chest that demonstrated reduction in ground-glass opacities [7, 12, 13] . Tocilizumab was well tolerated, except for six (6.5%) patients [3, 6, 10] . The results are encouraging (75% improved, remained stable or with moderate disease with Tocilizumab), but should be evaluated with caution due to the low quality of studies (retrospective nature, small sample size, missing data, no clear outcome measures). Future studies should focus on patient-centred outcome measures, such as death and prevention of ventilation. Randomization should also be considered in any future work. Additionally, the above positive findings could be misleading because of publication bias and the underreporting of negative studies. However, this preliminary evidence supports the consideration of tocilizumab in the research efforts in the fight against the COVID-19 hyper-inflammation response. In line with the above findings, on 27 April, the results of a French open-label randomized controlled trial (n ¼ 129) were announced by the Assistance Publique-Hô pitaux de Paris. A total of 129 patients with COVID-19, not requiring intensive care upon admission, were randomized equally to standard of care with tocilizumab and standard of care alone. According to the press release, a significantly lower proportion of patients reached the primary outcome (need for ventilation or The mean hospitalization time was 13.5 days after the treatment death at day 14) in the tocilizumab arm. Results of this study will be submitted for publication in a peerreviewed journal. There are still 32 ongoing clinical and observational trials registered on clinicaltrials.gov (accessed on 29 April 2020). However, these studies vary in participant and intervention criteria with several diverse primary and secondary outcomes. This may make future attempts of synthesizing the results across clinical trials difficult, leading to different policies in different countries. This heterogeneity highlights the global need to identify which is the right time and dosing scheme of tocilizumab for patients with COVID-19. Tocilizumab treatment in COVID-19: a single center experience COVID-19 in solid organ transplant recipients: initial report from the US epicenter Interleukin-6 blockade for severe COVID-19 Effective treatment of severe COVID-19 patients with tocilizumab Offlabel use of tocilizumab in patients with SARS-CoV-2 infection Letter to the Editor: acute hypertriglyceridemia in patients with COVID-19 receiving tocilizumab Favorable changes of CT findings in a patient with COVID-19 pneumonia after treatment with tocilizumab Rapid and severe Covid-19 pneumonia with severe acute chest syndrome in a sickle cell patient successfully treated with tocilizumab A case of novel coronavirus disease 19 in a chronic hemodialysis patient presenting with gastroenteritis and developing severe pulmonary disease Covid-19 pneumonia in a kidney transplant recipient successfully treated with tocilizumab and hydroxychloroquine Case study: a patient with asthma, Covid-19 pneumonia and cytokine release syndrome treated with corticosteroids and tocilizumab First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report A.-V.M. would like to thank Dr Jessica Manson, Rheumatology consultant at University College London Hospital, who instilled in her the interest in hyperinflammation syndromes.Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.Disclosure statement: M.B. has been sponsored to attend regional, national and international meetings by UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Janssen, Bristol-Myers Squib, Novartis and Eli-lilly. He has received honoraria for speaking and attended advisory boards with Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis. He has received honoraria from educational groups revalidaid and TREG consultants. The other author has declared no conflicts of interest.