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Tocilizumab and liver injury in patients with COVID-19
Current mortality rate in patients with COVID-19 disease is about 2%, whereas 5% of patients require admission to the intensive care unit. It is assumed that interleukin (IL)-6 may be involved in the pathogenesis of severe COVID-19 infections; therefore, in the absence of a specific antiviral therap...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545299/ https://www.ncbi.nlm.nih.gov/pubmed/33101458 http://dx.doi.org/10.1177/1756284820959183 |
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author | Serviddio, Gaetano Villani, Rosanna Stallone, Giovanni Scioscia, Giulia Foschino-Barbaro, Maria Pia Lacedonia, Donato |
author_facet | Serviddio, Gaetano Villani, Rosanna Stallone, Giovanni Scioscia, Giulia Foschino-Barbaro, Maria Pia Lacedonia, Donato |
author_sort | Serviddio, Gaetano |
collection | PubMed |
description | Current mortality rate in patients with COVID-19 disease is about 2%, whereas 5% of patients require admission to the intensive care unit. It is assumed that interleukin (IL)-6 may be involved in the pathogenesis of severe COVID-19 infections; therefore, in the absence of a specific antiviral therapy, some authors have suggested that tocilizumab – a drug used to block the signal transduction pathway of IL-6 – could have beneficial effects in the management of severe COVID-19 disease. However, mild-to-moderate elevation in transaminases and drug-induced liver injury have been observed in patients treated with tocilizumab. We present seven cases of patients with elevated liver enzymes [up to five times the upper limit of normal (ULN)] at baseline who received tocilizumab for life-threatening COVID-19 disease. All patients had no history of liver or pulmonary disease and were admitted for acute hypoxemic respiratory failure, dyspnea and fever due to COVID-19 bilateral pneumonia. IL-6 was available in six patients, and was significantly increased particularly in those with severe impairment of lung function. All patients received tocilizumab (8 mg/kg/day) for two consecutive days because of lack of improvement after hydroxychloroquine, azithromycin and lopinavir/ritonavir treatment. After tocilizumab administration, clinical condition rapidly improved and liver function test normalized within 3 weeks of treatment. Tocilizumab may be effective for the treatment of severe COVID-19 disease, even in patients with elevated liver function tests. Further studies are needed to evaluate the impact of tocilizumab use on liver function tests in patients with pre-existing chronic liver disease. |
format | Online Article Text |
id | pubmed-7545299 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-75452992020-10-09 Tocilizumab and liver injury in patients with COVID-19 Serviddio, Gaetano Villani, Rosanna Stallone, Giovanni Scioscia, Giulia Foschino-Barbaro, Maria Pia Lacedonia, Donato Therap Adv Gastroenterol Case Series Current mortality rate in patients with COVID-19 disease is about 2%, whereas 5% of patients require admission to the intensive care unit. It is assumed that interleukin (IL)-6 may be involved in the pathogenesis of severe COVID-19 infections; therefore, in the absence of a specific antiviral therapy, some authors have suggested that tocilizumab – a drug used to block the signal transduction pathway of IL-6 – could have beneficial effects in the management of severe COVID-19 disease. However, mild-to-moderate elevation in transaminases and drug-induced liver injury have been observed in patients treated with tocilizumab. We present seven cases of patients with elevated liver enzymes [up to five times the upper limit of normal (ULN)] at baseline who received tocilizumab for life-threatening COVID-19 disease. All patients had no history of liver or pulmonary disease and were admitted for acute hypoxemic respiratory failure, dyspnea and fever due to COVID-19 bilateral pneumonia. IL-6 was available in six patients, and was significantly increased particularly in those with severe impairment of lung function. All patients received tocilizumab (8 mg/kg/day) for two consecutive days because of lack of improvement after hydroxychloroquine, azithromycin and lopinavir/ritonavir treatment. After tocilizumab administration, clinical condition rapidly improved and liver function test normalized within 3 weeks of treatment. Tocilizumab may be effective for the treatment of severe COVID-19 disease, even in patients with elevated liver function tests. Further studies are needed to evaluate the impact of tocilizumab use on liver function tests in patients with pre-existing chronic liver disease. SAGE Publications 2020-10-07 /pmc/articles/PMC7545299/ /pubmed/33101458 http://dx.doi.org/10.1177/1756284820959183 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Case Series Serviddio, Gaetano Villani, Rosanna Stallone, Giovanni Scioscia, Giulia Foschino-Barbaro, Maria Pia Lacedonia, Donato Tocilizumab and liver injury in patients with COVID-19 |
title | Tocilizumab and liver injury in patients with COVID-19 |
title_full | Tocilizumab and liver injury in patients with COVID-19 |
title_fullStr | Tocilizumab and liver injury in patients with COVID-19 |
title_full_unstemmed | Tocilizumab and liver injury in patients with COVID-19 |
title_short | Tocilizumab and liver injury in patients with COVID-19 |
title_sort | tocilizumab and liver injury in patients with covid-19 |
topic | Case Series |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545299/ https://www.ncbi.nlm.nih.gov/pubmed/33101458 http://dx.doi.org/10.1177/1756284820959183 |
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