National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management

Nicastri, Emanuele; Petrosillo, Nicola; Bartoli, Tommaso Ascoli; Lepore, Luciana; Mondi, Annalisa; Palmieri, Fabrizio; D’Offizi, Gianpiero; Marchioni, Luisa; Murachelli, Silvia; Ippolito, Giuseppe; Antinori, Andrea

Severe life-threatening infections and alterations in blood parameters as ALT / AST >5 ULN, absolute neutrophils count <500 cell/mmc and platelet count <50000 cell/mmc are contraindications for TCZ treatment. Caution is required in special categories: pregnancy/breastfeeding, active /latent pulmonary tuberculosis, bacterial/fungal infections, immune-related rheumatic disease or concomitant therapy with anti-rejection drugs or immunomodulating therapies, hepatopaties (including viral hepatitis). The safety profile of TCZ is well known. In the TQT study, the most common marked laboratory abnormality was low neutrophil counts. Decreases were observed in mean neutrophil counts following single doses of TCZ over the first 2 days post-treatment, reaching a maximum at approximately 24 hours after the infusion. The observed incidence of marked decreases in neutrophil counts increased with the higher dose of TCZ. Thrombocytopenia and increase of liver function tests have also been described.