682. Is There a Role for the Early Use of Tocilizumab and Interleukin-6 Levels in the Management of SARS-CoV-2 Patients with Early Respiratory Failure?

Abstract

Background: The severity of respiratory failure in SARS-CoV-2 infection appears to be related to cytokine release syndrome (CRS), resulting in mechanical ventilation (MV). In this observational study, we investigated tocilizumab's role in the treatment of SARS-CoV-2 and the use of interleukin-6 (IL-6) levels in the management of these patients. Methods: Patients with positive SARS-CoV-2 PCR were prospectively observed from February 1, 2020 to May 31, 2020. Data on demographics, medical history, and clinical outcomes were collected. Tocilizumab (TCZ) 4 mg/kg/day q12h was given for 24 hours, followed by methylprednisolone 60 mg q8h for 72 hours to patients with oxygen requirement of 3 L and above. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimers were monitored on days: 0, 3, and 6 following the initiation of therapy. Statistical analyses were performed using a Wilcoxon signed-rank test with significance (α) less than or equal to 0.05 (P ≤ 0.05). Results: A total of eighty patients (45 males, 56.96%) and (34 females, 43.04%) with positive SARS-CoV-2 PCR were included in this study. The median age was 63 (51 - 72) years. Seven patients expired (8.75%), and nine patients required mechanical ventilation (11.25%). The median of IL-6 levels before administration of TCZ was 342.50 (78.25 - 666.25) pg/mL compared to after administration of TCZ on day 3, 563 (162-783) pg/mL (P < 0.00001). On day 6, the median dropped to 545 (333.50 - 678.50) pg/mL as compared to day 3 (P = 0.709). Moreover, CRP, ferritin, LDH, and D-dimers levels were reduced following the administration of TCZ. TABLE 1: IL-6 of SARS-CoV-2 patients at before and after Tocilizumab Treatment Conclusion: Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels, which may be useful inflammatory indices in the management of SARS-CoV-2 patients. Furthermore, the sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. The use of IL-6 levels may be helpful as a prognostic tool and in the management of acutely ill SARS-CoV-2 patients.