Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/28864
Title: | Tocilizumab for severe COVID-19 pneumonia: Case series of 5 Australian patients. | Authors: | Keat K.;Ojaimi S. ;Tran T. ;West T.A.;Malik S.;Nalpantidis A.;Cannon C.;Bhonagiri D.;Chan K.;Cheong E.;Wan Sai Cheong J.;Cheung W.;Choudhury F.;Ernest D. ;Farah C.S.;Fernando S.;Kanapathipillai R.;Kol M.;Murfin B. ;Naqvi H.;Shah A.;Wagh A.;Frankum B.;Riminton S. | Monash Health Department(s): | Haematology Intensive Care Infectious Diseases and Clinical Microbiology |
Institution: | (West, Frankum, Keat) Department of Immunology and Allergy, Campbelltown Hospital, Sydney, NSW, Australia (Malik, Farah, Riminton) Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia (Nalpantidis) Clinical Haematology Unit, Monash Health, Melbourne, VIC, Australia (Tran) Department of Medicine, Campbelltown Hospital, Sydney, NSW, Australia (Cannon) Department of Medicine, Concord Hospital, Sydney, NSW, Australia (Bhonagiri) Intensive Care Unit, Campbelltown Hospital, Sydney, NSW, Australia (Chan, Choudhury, Naqvi) Department of Respiratory Medicine, Campbelltown Hospital, Sydney, NSW, Australia (Cheong, Fernando) Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia (Wan Sai Cheong) School of Medicine, Western Sydney University, Sydney, NSW, Australia (Cheung, Kol, Shah, Wagh) Intensive Care Unit, Concord Hospital, Sydney, NSW, Australia (Ernest, Murfin) Intensive Care Unit, Monash Health, Melbourne, VIC, Australia (Kanapathipillai, Ojaimi) Monash Infectious Diseases, Monash University, Melbourne, VIC, Australia | Issue Date: | 24-Aug-2020 | Copyright year: | 2020 | Publisher: | Blackwell Publishing | Place of publication: | Australia | Publication information: | International Journal of Rheumatic Diseases. 23 (8) (pp 1030-1039), 2020. Date of Publication: 01 Aug 2020. | Journal: | International Journal of Rheumatic Diseases | Abstract: | Aim: To describe the first Australian cases of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) disease (COVID-19) pneumonia treated with the interleukin-6 receptor antagonist tocilizumab. Method(s): Retrospective, open-label, real-world, uncontrolled, single-arm case series conducted in 2 tertiary hospitals in NSW, Australia and 1 tertiary hospital in Victoria, Australia. Five adult male patients aged between 46 and 74 years with type 1 respiratory failure due to COVID-19 pneumonia requiring intensive care unit (ICU) admission and biochemical evidence of systemic hyperinflammation (C-reactive protein greater than 100 mg/L; ferritin greater than 700 mug/L) were administered variable-dose tocilizumab. Result(s): At between 13 and 26 days follow-up, all patients are alive and have been discharged from ICU. Two patients have been discharged home. Two patients avoided endotracheal intubation. Oxygen therapy has been ceased in three patients. Four adverse events potentially associated with tocilizumab therapy occurred in three patients: ventilator-associated pneumonia, bacteremia associated with central venous catheterization, myositis and hepatitis. All patients received broad-spectrum antibiotics, 4 received corticosteroids and 2 received both lopinavir/ritonavir and hydroxychloroquine. The time from first tocilizumab administration to improvement in ventilation, defined as a 25% reduction in fraction of inspired oxygen required to maintain peripheral oxygen saturation greater than 92%, ranged from 7 hours to 4.6 days. Conclusion(s): Tocilizumab use was associated with favorable clinical outcome in our patients. We recommend tocilizumab be included in randomized controlled trials of treatment for patients with severe COVID-19 pneumonia, and be considered for compassionate use in such patients pending the results of these trials.Copyright © 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/1756-185X.13913 | PubMed URL: | 32881350 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32881350] | ISSN: | 1756-1841 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/28864 | Type: | Article | Subjects: | single drug dose staphylococcal bacteremia/dt [Drug Therapy] staphylococcal bacteremia/si [Side Effect] ventilator associated pneumonia/dt [Drug Therapy] ventilator associated pneumonia/si [Side Effect] Victoria *virus pneumonia/dt [Drug Therapy] azithromycin/cb [Drug Combination] azithromycin/pv [Special Situation for Pharmacovigilance] C reactive protein/ec [Endogenous Compound] ceftriaxone/cb [Drug Combination] ceftriaxone/pv [Special Situation for Pharmacovigilance] ferritin/ec [Endogenous Compound] hydroxychloroquine/ae [Adverse Drug Reaction] hydroxychloroquine/cb [Drug Combination] hydroxychloroquine/dt [Drug Therapy] lopinavir plus ritonavir/ae [Adverse Drug Reaction] lopinavir plus ritonavir/cb [Drug Combination] lopinavir plus ritonavir/dt [Drug Therapy] methylprednisolone/cb [Drug Combination] methylprednisolone/dt [Drug Therapy] noradrenalin/cb [Drug Combination] piperacillin plus tazobactam/cb [Drug Combination] piperacillin plus tazobactam/dt [Drug Therapy] piperacillin plus tazobactam/iv [Intravenous Drug Administration] prednisone/cb [Drug Combination] prednisone/dt [Drug Therapy] prednisone/po [Oral Drug Administration] prednisone/pv [Special Situation for Pharmacovigilance] *tocilizumab/ae [Adverse Drug Reaction] *tocilizumab/cb [Drug Combination] *tocilizumab/iv [Intravenous Drug Administration] *tocilizumab/pv [Special Situation for Pharmacovigilance] vancomycin/dt [Drug Therapy] vancomycin/iv [Intravenous Drug Administration] fraction of inspired oxygen *tocilizumab/dt [Drug Therapy] acute kidney failure/th [Therapy] adult aged article artificial ventilation Australian catheter removal clinical article *coronavirus disease 2019/dt [Drug Therapy] cytokine release syndrome/dt [Drug Therapy] delirium/si [Side Effect] drug withdrawal endotracheal intubation eosinophilia/si [Side Effect] extubation fatty liver fever hepatitis/si [Side Effect] human hypoxia intensive care kidney failure/si [Side Effect] male middle aged myositis/si [Side Effect] New South Wales open study oxygen saturation oxygen therapy priority journal prone position QT prolongation/si [Side Effect] respiratory failure/th [Therapy] respiratory tract parameters retrospective study sedation single drug dose staphylococcal bacteremia ventilator associated pneumonia Victoria virus pneumonia azithromycin C reactive protein ceftriaxone ferritin hydroxychloroquine [Adverse Drug Reaction] hydroxychloroquine lopinavir plus ritonavir [Adverse Drug Reaction] lopinavir plus ritonavir methylprednisolone noradrenalin piperacillin plus tazobactam prednisone prednisone [Oral Drug Administration] tocilizumab [Adverse Drug Reaction] vancomycin fraction of inspired oxygen tocilizumab acute kidney failure aged artificial ventilation Australian catheter removal coronavirus disease 2019 cytokine release syndrome delirium drug withdrawal endotracheal intubation eosinophilia extubation fatty liver fever hepatitis hypoxia intensive care kidney failure myositis New South Wales oxygen saturation oxygen therapy prone position QT prolongation respiratory failure respiratory tract parameters sedation endotracheal intubation eosinophilia / side effect extubation fatty liver fever hepatitis / side effect human hypoxia intensive care kidney failure / side effect male middle aged myositis / side effect New South Wales open study oxygen saturation oxygen therapy priority journal prone position QT prolongation / side effect respiratory failure / therapy respiratory tract parameters retrospective study sedation single drug dose adult ventilator associated pneumonia / drug therapy / side effect Victoria *virus pneumonia / *drug therapy acute kidney failure / therapy clinical article staphylococcal bacteremia / drug therapy / side effect aged Article artificial ventilation Australian catheter removal *coronavirus disease 2019 / *drug therapy cytokine release syndrome / drug therapy delirium / side effect drug withdrawal |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.