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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...

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Autores principales: Serviddio, Gaetano, Villani, Rosanna, Stallone, Giovanni, Scioscia, Giulia, Foschino-Barbaro, Maria Pia, Lacedonia, Donato
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
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.
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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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