1. Home
  2. Vol 53, No 2 (2021)
  3. Syam

Tocilizumab as a Treatment for ‘Cytokine Storm Syndrome’ in COVID-19: A Case Report

Ari Fahrial Syam, Ceva W Pitoyo, Suhendro Suhendro, Benny Zulkarnain, Nuri D Indrasari, Dita Aditianingsih, Cosphiadi Irawan, Adityo Susilo, Cleopas M Rumende, Ika P Wijaya, Fera Ibrahim, Menaldi Rasmin, Idrus Alwi, Dadang Makmun

Abstract


Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects. 


Keywords


COVID-19; SARS-CoV-2; acute respiratory distress syndrome (ARDS); Tocilizumab

References


World Health Organization. Coronavirus disease 2019 (COVID-19) situation report. [Internet]. [cited 2020 Jun 29]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200628-covid-19-sitrep-160.pdf?sfvrsn=2fe1c658_2

Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm' in COVID-19. J Infect. 2020;80(6):607-613. doi:10.1016/j.jinf.2020.03.037

Shimabukuro-Vornhagen A, Godel P, Subklewe M, Stemmler HJ, Schlößer HA, Schlaak Max, et al. Cytokine release syndrome. J Immunother Cancer. 2018 Des;6(1):56

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Jan;395(10223):497-506

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet. 2020 March;395(10229):1033-1034. doi:10.1016/S0140-6736(20)30628-0

Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117(20):10970-10975. doi:10.1073/pnas.2005615117

(Ying H., Deng Q., He B., Pan Y., Wang F., Sun H., Chen J., Liu X., Wang S. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med. Oncol. (Northwood, Lond., Engl.) 2014;31(12):305).

Yang AP, Liu JP, Tao W, Li H. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients.Int Immunopharmacol. 2020 Jul; 84: 106504

Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: a single center experience. J Med Virol. 2020 Jul;92(7):814-818. doi: 10.1002/jmv.25801

Capra R. Rossi ND, Mattioli F, Romanelli G, Scarpazza C, Sormani MP, et al. Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia. Eur J Intern Med. 2020;76:31-35. doi:10.1016/j.ejim.2020.05.009

Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. The cytokine release syndrome (CRS) of severe COVID-19 and interleukin-6 receptor (IL-6R) antagonist tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020;55(5):105954. doi:10.1016/j.ijantimicag.2020.105954

Sinha P, Matthay MA, Calfee CS. Is a “Cytokine Storm” Relevant to COVID-19? JAMA Intern Med. 2020 Jun;E1-3. doi:10.1001/jamainternmed.2020.3313

Gubernatorova EO, Gorshkova EA, Polinova AI, Drutskaya MS. IL-6: relevance for immunopathology of SARS-CoV-2. Cytokine Growth Factor Rev. 2020;53:13-24. doi:10.1016/j.cytogfr.2020.05.009

Saha A, Sharma AR, Bhattacharya M, Sharma G, Lee SS, Chakraborty C. Tocilizumab: a therapeutic option for the treatment of cytokine storm syndrome in COVID-19. Arch Med Res. 2020; 51(6): 595-7. doi: 10.1016/j.arcmed.2020.05.009

Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368(6490):473-474. doi:10.1126/science.abb8925

Liu B, Li M, Zhou Z, Guan X, Xiang Y. Can we use interleukin-6 (IL-6) blockade fpr coronavirus disease 2019 (COVID-19)-induced cytokin release syndrome (CRS)?. J Autoimmun. 2020;111:102452.

Zhang S, Li L, Shen A, Chen Y, Qi Z. Rational use of tocilizumab in the treatment of novel coronavirus pneumonia. Clin Drug Investig. 2020;40(6):511-518. doi:10.1007/s40261-020-00917-3

World Health Organization. Clinical management of COVID-19 interim guidance. [internet]. [cited 2020 Jun 16]. Available from: https://apps.who.int/iris/handle/10665/332196


Full Text: PDF

Refbacks

  • There are currently no refbacks.