Thrombo‐inflammation response to Tocilizumab in COVID‐19

Gergi, Mansour; Cushman, Mary; Littenberg, Benjamin; Budd, Ralph C.

BACKGROUND: Coronavirus disease‐19 (COVID‐19) spans a wide spectrum of illness. Severe cases of COVID‐19 can manifest inflammation in organs other than the lung, in tissues not known to support viral replication, and also in a hypercoagulable state. These observations have suggested that SARS‐CoV‐2 can provoke a hyperimmune response in some cases that could lead to secondary organ damage. METHODS: With evidence of elevated levels of interleuking‐6 (IL‐6) in patients with severe COVID‐19, we conducted a small pilot off‐label compassionate care study of the IL‐6 receptor inhibitor tocilizumab patients with severe COVID‐19. RESULTS: Following a single infusion of tocilizumab in patients with severe manifested rapid declines in C‐reactive protein (CRP), D‐Dimer, and gradual rises in lymphocyte and platelet counts. CONCLUSIONS: These findings suggest both pathophysiological mechanisms as well as clinical benefit that might be seen with IL‐6 inhibition in severe COVID‐19.