Title:Tocilizumab in SARS-COV-2 Patients with the Syndrome of Cytokine Storm: A Narrative review
VOLUME: 15
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: Coronavirus is a group of viruses which causes diseases in mammals and birds. In humans, these
family of viruses can cause the respiratory infections from mild form to fatal forms. It is preferably called as coronavirus.
Formally it known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or 2019 novel coronavirus (2019-
nCoV) and this disease is called as coronavirus disease 2019 (COVID-19). SARS-CoV-2 is infectious in humans and
world health organization has announced that Covid-19 as a pandemic disease. Tocilizumab is a biological agent which
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 positive effect in patients with covid-19.
Purpose of the Study: 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: The search strategy on recent research and review articles is used for the SARS-CoV-2 disease
and their characteristics. Furthermore we have analyzed most recent research article on monoclonal antibody against IL-6
receptors (tocilizumab) and their possible clinical effects in Covid-19 and their clinical trials on Covid-19 patients.
Results and Conclusion: 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 treatment for covid-19 globally.
Furthermore we can conclude that SARS-CoV-2 is associated with 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.
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. has shown the efficacy of tocilizumab in severe and critically ill covid-19 patients. However we need more
randomized research studies with significant number of patients which can confirm the promising results on tocilizumab
treatment in covid-19 patients and even ongoing clinical trails such as TOSCA, COVACTA results has not been published
yet which are expected to give better and more significant results on tocilizumab’s effectiveness and safety.
