托珠单抗治疗 COVID-19:单中心经验。

Tocilizumab treatment in COVID-19: A single center experience.

机构信息

Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

J Med Virol. 2020 Jul;92(7):814-818. doi: 10.1002/jmv.25801. Epub 2020 Apr 15.

Abstract

Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms recently. In the present study, we aimed to discuss the treatment response of TCZ therapy in COVID-19 infected patients. The demographic, treatment, laboratory parameters of C-reactive protein (CRP) and IL-6 before and after TCZ therapy and clinical outcome in the 15 COVID-19 patients were retrospectively assessed. Totally 15 patients with COVID-19 were included in this study. Two of them were moderately ill, six were seriously ill and seven were critically ill. The TCZ was used in combination with methylprednisolone in eight patients. Five patients received the TCZ administration twice or more. Although TCZ treatment ameliorated the increased CRP in all patients rapidly, for the four critically ill patients who received an only single dose of TCZ, three of them (No. 1, 2, and 3) still dead and the CRP level in the rest one patient (No. 7) failed to return to normal range with a clinical outcome of disease aggravation. Serum IL-6 level tended to further spiked firstly and then decreased after TCZ therapy in 10 patients. A persistent and dramatic increase of IL-6 was observed in these four patients who failed treatment. TCZ appears to be an effective treatment option in COVID-19 patients with a risk of cytokine storms. And for these critically ill patients with elevated IL-6, the repeated dose of the TCZ is recommended.

摘要

托珠单抗(TCZ)是一种针对白细胞介素-6(IL-6)的单克隆抗体,最近成为治疗 COVID-19 患者细胞因子风暴风险的一种替代疗法。在本研究中,我们旨在讨论 TCZ 治疗 COVID-19 感染患者的治疗反应。回顾性评估了 15 例 COVID-19 患者的人口统计学、治疗、C 反应蛋白(CRP)和 IL-6 治疗前后的实验室参数以及临床结局。

总共纳入了 15 例 COVID-19 患者。其中 2 例为中度疾病,6 例为严重疾病,7 例为危重症。8 例患者联合使用 TCZ 和甲基强的松龙,5 例患者接受了两次或更多次 TCZ 治疗。尽管 TCZ 治疗迅速改善了所有患者 CRP 的升高,但对于仅接受单次 TCZ 治疗的 4 例危重症患者,其中 3 例(No.1、2 和 3)仍死亡,CRP 水平未能恢复正常范围,病情加重。在 10 例患者中,TCZ 治疗后血清 IL-6 水平先升高后降低。在这 4 例治疗失败的患者中,观察到 IL-6 持续且显著增加。

TCZ 似乎是 COVID-19 患者细胞因子风暴风险的有效治疗选择。对于这些 IL-6 升高的危重症患者,建议重复 TCZ 剂量。

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