Chaudhry Dhruva, Singh Pawan K
Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Indian J Crit Care Med. 2020 Sep;24(9):741-743. doi: 10.5005/jp-journals-10071-23608.
The number of cases in COVID-19 pandemic is rising rapidly. There has not been a single effective proven medication for COVID-19 disease. Highest mortality has been reported among subjects who develop acute respiratory disease (ARDS). The histopathological analysis of lung specimens has given rise to theories that propose the major role of cytokine release syndrome in the development of ARDS. IL-6 has often been found to be raised in subjects having severe disease. Tocilizumab is a selective inhibitor of the IL-6 pathway and has been approved for various rheumatological diseases. Its use in COVID-19 has been evaluated following the success of other immunosuppressive drugs like steroids. The data in support of against its use in COVID19 are lacking. Similarly, the risk of early- and late-onset infections after tocilizumab in COVID-19 remains unknown. The study by Nasa et al. is a valuable addition to the evidence concerning its use. Despite multiple articles, its safety and efficacy in COVID-19 remain unknown. Caution must be used about its timing and role of IL-6 levels for disease monitoring. Chaudhry D, Singh PK. Tocilizumab and COVID-19. Indian J Crit Care Med 2020;24(9):741-743.
新型冠状病毒肺炎大流行中的病例数正在迅速上升。目前尚未有经证实有效的治疗新型冠状病毒肺炎的药物。据报道,在发生急性呼吸窘迫综合征(ARDS)的患者中死亡率最高。对肺标本的组织病理学分析引发了一些理论,这些理论认为细胞因子释放综合征在ARDS的发生发展中起主要作用。在患有严重疾病的患者中,经常发现白细胞介素-6(IL-6)升高。托珠单抗是IL-6通路的选择性抑制剂,已被批准用于多种风湿性疾病。继类固醇等其他免疫抑制药物取得成功后,其在新型冠状病毒肺炎中的应用也得到了评估。目前缺乏支持或反对其在新型冠状病毒肺炎中使用的数据。同样,新型冠状病毒肺炎患者使用托珠单抗后早发和迟发感染的风险仍然未知。纳萨等人的研究为有关其使用的证据增添了有价值的内容。尽管有多篇文章,但托珠单抗在新型冠状病毒肺炎中的安全性和有效性仍然未知。在使用托珠单抗时必须谨慎,并注意IL-6水平在疾病监测中的时机和作用。乔杜里D,辛格PK。托珠单抗与新型冠状病毒肺炎。《印度重症监护医学杂志》2020;24(9):741 - 743。
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