Tocilizumab is associated with reduction in inflammation and improvement in P/F ratio in critically sick COVID19 patients

  1. Muhammad Asim Rana
  2. Mubashar Hashmi
  3. Muhammad Muneeb Ullah Saif
  4. Muhammad Faisal Munir
  5. Ahad Qayyum
  6. Rizwan Pervaiz
  7. Muhammad Mansoor Hafeez

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Abstract

Introduction

Coronavirus disease 2019 was initially detected in China and has been declared a global pandemic by World Health Organization on March 11, 2020. In the majority of patients, SARS□CoV□2 causes a mild to moderate illness characterized by fever and respiratory symptoms, with or without evidence of pneumonia. The recent studies suggest that anti-cytokine targeted therapies might be associated with benefit for patients with severe COVID-19 especially in improving respiratory failure. Tocilizumab, a monoclonal antibody against interleukin 6 (IL6) receptor, is associated with clinical benefit for COVID-19 patients as it inhibits IL6 and decreases inflammation.

Methods

As Tocilizumab has been an important part of our treatment and a strict criterion was followed to administer Tocilizumab, a retrospective study design used to assess the beneficial effects of Tocilizumab in improvement of ratio partial pressure of arterial Oxygen and fraction of inspired Oxygen (PaO 2 /FiO 2 or P/F ratio) and C-reactive protein (CRP) in COVID19 patients has been done. 60 patients were taken for this study by using convenient sampling technique the data of demographics, laboratory results, and clinical outcomes i.e. improvement of respiratory failure depicted in the form of PF Ratio were obtained from the medical records, Statistical analysis was done with SPSS, version 21.0.

Results

Sixty patients (47 males and 13 females) with COVID□19 were included in this study, the mean age of patients was 53.83 (14□81) years. After administration of Tocilizumab the lab parameters were changed as CRP decreased down to .40 (9.6□73) mg/L but other parameters were not affected. The PF ratio improved in COVID-19 patients after administration of Tocilizumab the median of PF Ratio before treatment was 108 (52□362) and improved up to 128 (37□406) after Tocilizumab therapy.

Conclusion

In summary, Tocilizumab appears to be associated with improvement in P/F Ratio and CRP in COVID19 patients but other markers did not improve in response to Tocilizumab therapy in severely ill COVID-19 patients.

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    SciScore for 10.1101/2020.10.20.20210195: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: The study was approved by the ethical committee of Bahria International Hospital Lahore.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was done with SPSS, version 21.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  2. Version published to 10.1101/2020.10.20.20210195v1 on medRxiv