Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia

Inflammation plays a major role in the pathophysiology of COVID-19, and corticosteroids are validated as initial potent broad-spectrum anti-inflammatory agents. IL-6 is one of the culprit pro-inflammatory cytokines identified for this cytokine storm. Tocilizumab is a recombinant humanized monoclonal...

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Main Authors: Sameer Bansal, Uma Karjigi, Ravindra M Mehta
Format: Article
Language:English
Published: SAGE Publishing 2021-01-01
Series:Apollo Medicine
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Online Access:http://www.apollomedicine.org/article.asp?issn=0976-0016;year=2021;volume=18;issue=3;spage=189;epage=191;aulast=Bansal
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author Sameer Bansal
Uma Karjigi
Ravindra M Mehta
author_facet Sameer Bansal
Uma Karjigi
Ravindra M Mehta
author_sort Sameer Bansal
collection DOAJ
description Inflammation plays a major role in the pathophysiology of COVID-19, and corticosteroids are validated as initial potent broad-spectrum anti-inflammatory agents. IL-6 is one of the culprit pro-inflammatory cytokines identified for this cytokine storm. Tocilizumab is a recombinant humanized monoclonal antibody that inhibits binding of interleukin (IL)-6 to both membrane and soluble IL-6 receptors. The role of tocilizumab was controversial with conflicting evidence, but recent data validate the use of this agent under specific circumstances of rapidly worsening COVID acute respiratory distress syndrome with escalating respiratory support or gradually worsening COVID-19 pneumonia in a hospital setting. One of the benchmark tocilizumab studies is the REMAP-CAP trial that showed the benefit of IL-6 antagonists in terms of survival, number of organ support-free days, and even probability of discharge from the hospital. This benefit was seen when tocilizumab was administered within 24 h of patients requiring either respiratory or hemodynamic support. A recently concluded meta-analysis showed that tocilizumab treatment predicts better overall survival in COVID-19 patients (hazard ratio [HR] =0.45, 95% confidence interval [CI]: 0.24–0.84, P = 0.01), especially in severe cases (HR = 0.58, 95% CI: 0.49–0.68, P < 0.00001).
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spelling doaj-art-2385fbd5fad7415394d40d870324d83e2025-01-02T10:10:58ZengSAGE PublishingApollo Medicine0976-00162213-36822021-01-0118318919110.4103/am.am_88_21Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumoniaSameer BansalUma KarjigiRavindra M MehtaInflammation plays a major role in the pathophysiology of COVID-19, and corticosteroids are validated as initial potent broad-spectrum anti-inflammatory agents. IL-6 is one of the culprit pro-inflammatory cytokines identified for this cytokine storm. Tocilizumab is a recombinant humanized monoclonal antibody that inhibits binding of interleukin (IL)-6 to both membrane and soluble IL-6 receptors. The role of tocilizumab was controversial with conflicting evidence, but recent data validate the use of this agent under specific circumstances of rapidly worsening COVID acute respiratory distress syndrome with escalating respiratory support or gradually worsening COVID-19 pneumonia in a hospital setting. One of the benchmark tocilizumab studies is the REMAP-CAP trial that showed the benefit of IL-6 antagonists in terms of survival, number of organ support-free days, and even probability of discharge from the hospital. This benefit was seen when tocilizumab was administered within 24 h of patients requiring either respiratory or hemodynamic support. A recently concluded meta-analysis showed that tocilizumab treatment predicts better overall survival in COVID-19 patients (hazard ratio [HR] =0.45, 95% confidence interval [CI]: 0.24–0.84, P = 0.01), especially in severe cases (HR = 0.58, 95% CI: 0.49–0.68, P < 0.00001).http://www.apollomedicine.org/article.asp?issn=0976-0016;year=2021;volume=18;issue=3;spage=189;epage=191;aulast=Bansalcovid-19interleukin 6tocilizumab
spellingShingle Sameer Bansal
Uma Karjigi
Ravindra M Mehta
Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
Apollo Medicine
covid-19
interleukin 6
tocilizumab
title Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
title_full Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
title_fullStr Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
title_full_unstemmed Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
title_short Tocilizumab: A potent immunomodulatory agent in the treatment of COVID-19 pneumonia
title_sort tocilizumab a potent immunomodulatory agent in the treatment of covid 19 pneumonia
topic covid-19
interleukin 6
tocilizumab
url http://www.apollomedicine.org/article.asp?issn=0976-0016;year=2021;volume=18;issue=3;spage=189;epage=191;aulast=Bansal
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AT umakarjigi tocilizumabapotentimmunomodulatoryagentinthetreatmentofcovid19pneumonia
AT ravindrammehta tocilizumabapotentimmunomodulatoryagentinthetreatmentofcovid19pneumonia