Effective treatment of severe COVID-19 patients with tocilizumab
Effective treatment of severe COVID-19 patients with tocilizumab
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DOI：
10.1073/pnas.2005615117
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发表时间：
2020-05-19
影响因子：
11.1
通讯作者：
Wei, Haiming
中科院分区：
文献类型：
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作者：
Xu, Xiaoling;Han, Mingfeng;Wei, Haiming
通过分析COVID-19患者的免疫特征，我们发现病原性T细胞和大量分泌白细胞介素6的炎性单核细胞可能会引发炎症风暴，而针对IL-6通路的单克隆抗体可能会抑制炎症风暴。在这里，我们旨在评估tocilizumab在重症COVID-19患者中的疗效，并寻求治疗策略。2020年2月5日至14日，在中国科学技术大学第一附属医院（安徽省立医院）和安徽省阜阳市第二人民医院确诊的COVID-19重症或危重型患者在常规治疗的基础上给予托珠单抗治疗。回顾性分析其临床表现、CT扫描图像及实验室检查的变化。第一天发热恢复正常，几天内其他症状明显改善。在托珠单抗治疗后5 d内，20例患者中有15例（75.0%）降低了吸氧量，1例患者无需吸氧。CT扫描显示19例（90.5%）患者肺病灶混浊吸收。治疗前85.0%（17/20）患者外周血淋巴细胞百分比下降（平均15.52 +/- 8.89%），治疗后第5天52.6%（10/19）患者外周血淋巴细胞百分比恢复正常。异常升高的c反应蛋白在84.2%的患者中显著降低（16/19）。未见明显不良反应。所有患者在给予托珠单抗后平均15.1 d出院。初步数据显示，托珠单抗可立即改善COVID-19重症和危重症患者的临床结果，是降低死亡率的有效治疗方法。
After analyzing the immune characteristics of patients with severe coronavirus disease 2019 (COVID-19), we have identified that pathogenic T cells and inflammatory monocytes with large amount of interleukin 6 secreting may incite the inflammatory storm, which may potentially be curbed through monoclonal antibody that targets the IL-6 pathways. Here, we aimed to assess the efficacy of tocilizumab in severe patients with COVID-19 and seek a therapeutic strategy. The patients diagnosed as severe or critical COVID-19 in The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) and Anhui Fuyang Second People's Hospital were given tocilizumab in addition to routine therapy between 5 and 14 February 2020. The changes of clinical manifestations, computerized tomography (CT) scan image, and laboratory examinations were retrospectively analyzed. Fever returned to normal on the first day, and other symptoms improved remarkably within a few days. Within 5 d after tocilizumab, 15 of the 20 patients (75.0%) had lowered their oxygen intake, and 1 patient needed no oxygen therapy. CT scans manifested that the lung lesion opacity absorbed in 19 patients (90.5%). The percentage of lymphocytes in peripheral blood, which decreased in 85.0% of patients (17/20) before treatment (mean, 15.52 +/- 8.89%), returned to normal in 52.6% of patients (10/19) on the fifth day after treatment. Abnormally elevated C-reactive protein decreased significantly in 84.2% of patients (16/19). No obvious adverse reactions were observed. All patients have been discharged on average 15.1 d after giving tocilizumab. Preliminary data show that tocilizumab, which improved the clinical outcome immediately in severe and critical COVID-19 patients, isan effective treatment to reduce mortality.