Title:Tocilizumab in SARS-COV-2 Patients with the Syndrome of Cytokine Storm: A Narrative review
VOLUME: 16 ISSUE: 2
Author(s):Shanmugaraj Kulanthaivel*, Vitalii B. Kaliberdenko, Keerthanaa Balasundaram, Michael V. Shterenshis, Emidio Scarpellini and Ludovico Abenavoli
Affiliation:Department of Internal Medicine No.2, V.I. Vernadsky Crimean Federal University, Simferopol, Department of Internal Medicine No.2, V.I. Vernadsky Crimean Federal University, Simferopol, Department of Internal Medicine No.2, V.I. Vernadsky Crimean Federal University, Simferopol, Science Research Department, Alexander Muss Institute for Israel Education (AMIIE), Hod Hasharon, Clinical Nutrition Unit and Internal Medicine Unit, Madonna del Soccorso General Hospital, Via Luciano Manara 7, 63074 San Benedetto del Tronto (AP), Department of Health Sciences, Magna Graecia University, Catanzaro
Keywords:SARS-CoV-2, tocilizumab, Covid-19, interleukin 6 (IL-6), cytokine release syndrome, cytokine storm, acute respiratory
distress syndrome, interstitial pneumonia.
Abstract:Introduction: Corona virus is a group of viruses that cause diseases in mammals and
birds. In humans, these families of viruses can cause respiratory infections from a mild form to fatal.
It is preferably called coronavirus. Formally, it is known as severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) or 2019 novel coronavirus (2019-nCoV) and this disease is called
coronavirus disease 2019 (COVID-19). SARS-CoV-2 is infectious in humans and the world health
organization has announced COVID-19 as pandemic disease. Tocilizumab is a biological agent
that inhibits the cytokine, interleukin 6 (IL-6 inhibitor). As SARS-CoV-2 infection leads to the development
of cytokine storm syndrome, the drug, tocilizumab, seems to have a positive effect on
patients with COVID-19.
Aim: To analyze and review the possible effects and efficacy of the tocilizumab (monoclonal antibody
against IL-6 receptors) in SARS-CoV-2 patients.
Materials and Methods: A search was carried out for all recent review articles, which were used to
study the SARS-CoV-2 disease and their characteristics. Furthermore, we have analyzed the most
recent research articles on monoclonal antibody against IL-6 receptors (tocilizumab) and their possible
clinical effects in COVID-19 and its’ clinical trials.
Results: COVID-19 is a disease caused by SARS-CoV-2 infection. It is a life threatening condition,
which can give rise to fatal outcomes if left untreated. However, there are no approved treatments
for COVID-19 globally. Furthermore, we can conclude that SARS-CoV-2 is associated with
the worsening of lung conditions, characterized by interstitial pneumonia with acute respiratory distress
syndrome as a result of cytokine storm syndrome. According to available research data, tocilizumab,
a recombinant humanized anti-human monoclonal antibody of IgG1τ (gamma 1, kappa),
can improve patient’s condition from cytokine storm syndrome by inhibiting the IL-6 (Interleukin
6) receptors.
Conclusion: The rational use of the tocilizumab in severe and critically ill COVID-19 patients can
prevent the development of irreversible lung injury and death of the patient. Three retrospective
studies of Xiaoling Xu et al., Pan luo et al., and Paola Tonaiti et al. have shown the efficacy of tocilizumab
in severe and critically ill COVID-19 patients. However, we need more randomized research
studies with a significant number of patients which can confirm the promising results on tocilizumab
treatment in COVID-19 patients. Moreover, ongoing clinical trails such as TOSCA, COVACTA
results have not been published yet which are expected to give better and more significant
results on tocilizumab’s effectiveness and safety.
