Publication: Role of Tocilizumab in the Treatment of COVID-19 Patients with Cytokine Storm: A Case Series
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms.
Description
Ajaya Basnet
Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Maharajgunj, Kathmandu, Nepal
Mahendra Raj Shrestha
Department of Clinical Laboratory, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Rossu Thapa
Department of Radiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Basanta Tamang
Department of Clinical Laboratory, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Apurba Shrestha
Department of Internal Medicine, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Prabhat Rawal
Department of Anaesthesiology and Critical Care, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Sailendra Kumar Duwal Shrestha
Department of Orthopedic and Trauma Services, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
Lochan Karki
Department of Medicine, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal
Shiba Kumar Rai
Research Department, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
Keywords
COVID-19, Cytokines, Interleukin-6