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  2. Vol 53, No 4 (2021)
  3. Suwenny

Herpes Zoster After Tocilizumab Therapy in COVID-19 Survivor: A Case Report

Suwenny Suwenny, Sahat Halim

Abstract


The COVID-19 pandemic has become a concern for the world community. However, despite abundant attempts taking place, there is currently no definitive therapy for COVID-19 yet. The clinical approaches recently adopted are the provision of antiviral therapy and immunomodulators. One of the immunomodulators that are currently being researched is tocilizumab, an IL-6 receptor antagonist monoclonal antibody. Many case studies and retrospective observational studies have shown that there is a chance that tocilizumab could diminish death rates in COVID-19 patients with severe or critical symptoms. Along with the growing use of tocilizumab in the COVID-19 cases that are emergent in nature, the occurrence of unpredictable adverse effects of the drugs have also been raising.  This case report describes a COVID-19 confirmed patient with severe symptoms who was given tocilizumab in addition to standard therapy. The patient developed Herpes Zoster infection which was suspected to be related to the adverse effects of using tocilizumab, which is known for its likelihood to increase the risk of new infections and also probably reactivate latent infections. Tocilizumab use seems to be effective in combating cytokine storm associated with severe COVID-19 infection. The possibility of serious adverse effects in the utilization of tocilizumab, though rare, cannot be excluded. The presence of a latent or chronic infection that can undergo reactivation should be a consideration for appropriate screening or prophylaxis before administering tocilizumab.

Keywords


COVID-19; Tocilizumab; Herpes Zoster; adverse drug effects; cytokine storm

References


Chen X, Zhao B, Qu Y, et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely associated with drastically elevated interleukin 6 (IL-6) level in critically ill patients with COVID-19. Clin Infect Dis [Internet]. 2020;71(8):1937-1942. Available from: https://doi.org/10.1093/cid/ciaa449.

Sheppard M, Laskou F, Stapleton PP, Hadavi S, Dasgupta B. Tocilizumab (Actemra). Human Vaccines & Immunotherapeutics [Internet]. 2017, 13(9), 1972-1988. Available from: https://doi.org/10.1080/21645515.2017.1316909.

Gatti M, Fusaroli M, Caraceni P, Poluzzi E, Ponti FD, Raschi E. Serious adverse events with tocilizumab: Pharmacovigilance as an aid to prioritize monitoring in COVID-19. Br J Clin Pharmacol [Internet]. 2020;1–8. Available from: https://doi.org/10.1111/bcp.14459.

Kementerian Kesehatan RI. Pedoman Pencegahan dan Pengendalian Coronavirus Disease (COVID-19). Juli 2020.

Perhimpunan Dokter Paru Indonesia. Panduan Praktik Klinik (PPK) Tatalaksana Pasien COVID-19. April 2020.

Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents [Internet]. 2020;55(5):105954. Available from: http://www.sciencedirect.com/science/article/pii/S0924857920301047.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet [Internet]. 2020; 395: 497–506. Available from: https://doi.org/10.1016/S0140-6736(20)30183-5.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet [Internet]. 2020;395(10223):507-513. Available from: https://doi.org/10.1016/S0140-6736(20)30211-7.

Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol [Internet]. 2020;92(7):814–8. Available from: https://doi.org/10.1002/jmv.25801.

Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A [Internet]. 2020;117(20):10970–5. Available from: https://doi.org/10.1073/pnas.2005615117.

Sciascia S, Apra F, Baffa A, et al. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol [Internet]. 2020;38(3):529–32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32359035.

Keske S, Tekin S, Sait B, et al. Appropriate use of tocilizumab in COVID-19 infection. Int J Infect Dis [Internet]. 2020;99:338–43. Available from: http://www.sciencedirect.com/science/article/pii/S1201971220305804.

Boregowda U, Perisetti A, Nanjappa A, Gajendran M, Kutti Sridharan G, Goyal H. Addition of Tocilizumab to the standard of care reduces mortality in severe COVID-19: A systematic review and meta-analysis. Front Med [Internet]. 2020;7:586221. Available from: https://pubmed.ncbi.nlm.nih.gov/33123544.

Kaye AG, Siegel R. The efficacy of IL-6 inhibitor Tocilizumab in reducing severe COVID-19 mortality: a systematic review. PeerJ [Internet]. 2020 Nov 2;8:e10322–e10322. Available from: https://pubmed.ncbi.nlm.nih.gov/33194450.

Dastan F, Saffaei A, Haseli S, et al. Promising effects of tocilizumab in COVID-19: A non-controlled, prospective clinical trial. Int Immunopharmacol [Internet]. 2020 Nov;88:106869. Available from: https://doi.org/10.1016/j.intimp.2020.106869.

Higuchi T, Nakanishi T, Takada K, et al. A case of multicentric Castleman’s disease having lung lesion successfully treated with humanized anti-interleukin-6 receptor antibody, tocilizumab. J Korean Med Sci [Internet]. 2010;25(9):1364–7. Available from: https://doi.org/10.3346/jkms.2010.25.9.1364.

Khiali S, Khani E, Entezari-Maleki T. A Comprehensive Review of Tocilizumab in COVID-19 Acute Respiratory Distress Syndrome. J Clin Pharmacol [Internet]. 2020/07/27. 2020;60(9):1131–46. Available from: https://pubmed.ncbi.nlm.nih.gov/32557541.

Jones G, Sebba A, Gu J, et al. Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis [Internet]. 2010;69(1):88–96. Available from: https://doi.org/10.1136/ard.2008.105197.

Alexeeva EI, Baranov AA, Denisova RV, et al. Retrospective analysis of efficacy and safety of Tocilizumab treatment in patients with severe systemic-onset juvenile idiopathic arthritis followed for 12 months. Hellstrom I, Boon A, Kapsogeorgou EK, editors. ISRN Immunol [Internet]. 2013;2013:548312. Available from: https://doi.org/10.1155/2013/548312.

Alattar R, Ibrahim TBH, Shaar SH, et al. Tocilizumab for the treatment of severe coronavirus disease 2019. J Med Virol [Internet]. 2020;1–8. Available from: https://doi.org/10.1002/jmv.25964.

Guaraldi G, Meschiari M, Cozzi-Lepri A, et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol [Internet]. 2020;2(8):e474–84. Available from: https://doi.org/10.1016/S2665-9913(20)30173-9.

Cantini F, Nannini C, Niccoli L, Petrone L, Ippolito G, Goletti D. Risk of Tuberculosis reactivation in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis receiving non-anti-TNF-targeted biologics. Mediators Inflamm [Internet]. 2017;2017:8909834. Available from: https://doi.org/10.1155/2017/8909834.

Lin CT, Huang WN, Hsieh CW, et al. Safety and effectiveness of Tocilizumab in treating patients with rheumatoid arthritis – A three-year study in Taiwan. J Microbiol Immunol Infect [Internet]. 2019 Feb;52(1):141-150. Available from: https://doi.org/10.1016/j.jmii.2017.04.002.

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med [Internet]. 2020;8(5):475–81. Available from: http://www.sciencedirect.com/science/article/pii/S2213260020300795.


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