Late onset infectious complications and safety of tocilizumab in the management of COVID‐19
Journal of Medical Virology, 2021•Wiley Online Library
Background Tocilizumab (TCZ) has been used in the management of COVID‐19‐related
cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug‐
related toxicities. We sought to evaluate the incidence of these TCZ complications among
COVID‐19 patients. Methods All adult inpatients with COVID‐19 between 1 March and 25
April 2020 that received TCZ were included. We compared the rate of late‐onset infections
(> 48 hours following admission) to a control group matched according to intensive care unit …
cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug‐
related toxicities. We sought to evaluate the incidence of these TCZ complications among
COVID‐19 patients. Methods All adult inpatients with COVID‐19 between 1 March and 25
April 2020 that received TCZ were included. We compared the rate of late‐onset infections
(> 48 hours following admission) to a control group matched according to intensive care unit …
Background
Tocilizumab (TCZ) has been used in the management of COVID‐19‐related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug‐related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID‐19 patients.
Methods
All adult inpatients with COVID‐19 between 1 March and 25 April 2020 that received TCZ were included. We compared the rate of late‐onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post‐TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion‐related reactions.
Results
Seventy‐four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (P = .013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, P = .03).
Conclusion
Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ‐related toxicities, 61% of patients had a possible post‐TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID‐19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use.
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