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New research shows sub-set of critically unwell COVID-19 patients respond to treatment with tocilizumab

Posted 28 July, 2020

A study published in the journal (opens in a new window)RESPIROLOGY shows that treatment with tocilizumab (a humanized monoclonal antibody which is used to treat inflammatory arthritis) may deliver a favourable outcome in patients with COVID-19 pneumonia and hyperinflammatory response in the pre-ICU setting. A subset of individuals with COVID-19 present with severe pneumonia, which in some cases evolves to acute respiratory distress syndrome (ARDS), coupled with hyperinflammatory syndrome (systemic inflammation).

ARDS is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs and hyperinflammatory syndrome is a serious condition in which there is inflammation throughout the whole body and is marked by increasing heart rate, low blood pressure, low or high body temperature, and low or high white blood cell count. This condition may lead to multiple organ failure and shock.

193 patients with confirmed COVID-19 were admitted to SVUH between 7th March – 7th April 2020. All 193 patients were enrolled into the All-Ireland Infectious Diseases Cohort Study, a multi-centre, prospective cohort study led by Professor Paddy Mallon, Professor of Microbial Diseases, UCD School of Medicine and Consultant in Infectious Diseases, SVUH. Patients were considered for tocilizumab based on presence of severe COVID-19 pneumonia and evidence of a hyperinflammatory response, following discussion at MDT case conferences.

Use of tocilizumab was avoided in those with imminent requirement for intubation/mechanical ventilation, known immunosuppression, active malignancy, uncontrolled bacterial infection, any indication of liver damage or a history of significant gastrointestinal ulcerative disease. Of the 193 cases, eight (4.1%) patients were considered for tocilizumab therapy and six of these patients were then treated with a single dose of intravenous tocilizumab at 8mg/kg (maximum dose 800mg).

Speaking about the findings from the study, Lead Author, Dr Cormac McCarthy, Consultant Respiratory Physician, SVUH and Associate Professor of Medicine, UCD School of Medicine said ‘a rapid decline in inflammatory markers and decreased oxygen requirements was seen in the six patients following administration of tocilizumab. None of these patients received other concurrent immunosuppressive therapy, providing a clearer indication of the positive effect of a single dose of tocilizumab in this setting and all patients were subsequently discharged home after an average of seven days following the treatment.”

“This study suggests that treatment with tocilizumab in the pre-ICU setting where patients are critically unwell may avoid the need for mechanical ventilation and may deliver a favourable outcome. However, there should be caution in interpreting these results due to a number of considerations, including the small cohort of patients, the patient group being relatively young, and the absence of an appropriately matched control group. Randomized controlled trials are now required to determine the true efficacy and safety of tocilizumab in COVID-19. An open-label trial to examine ‘COVIRL002 – Tocilizumab for management of severe non-critical COVID-19 infection’ in SVUH and Mater Hospital led by Prof Paddy Mallon is however already in train” continued Dr McCarthy.

Also speaking about the publication of this study in RESPIROLOGY, Professor Peter Doran, Associate Dean for Research, Innovation and Impact, UCD School of Medicine said ‘Research teams from the UCD School of Medicine which comprise clinicians at the frontline providing care for COVID-19 patients are leading research programmes that seek to further understanding of the virus and improve preventative measures and treatment. 

The School also established a COVID-19 Research Group in March 2020 aiming to ensure that UCD is leading the push back against the pandemic.

By: Staff Writers, UCD University Relations (with materials from UCD School of Medicine)