Tocilizumab:
Tocilizumab first humanized recombinant monoclonal antibody used to
treat inflammatory and autoimmune conditions. It is an Immunoglobulin
belongs to the G1 class (IgG1 class) that interacts with the soluble
interleukin 6 receptor (sIL-6R). It is an IL-6 receptor antagonist. IL-6
is a proinflammatory cytokine involved in fibrosis of tissues,
metabolism of lipids, T-cells activation. Tocilizumab is FAD approved
for the treatment of severe rheumatoid arthritis, systemic juvenile
idiopathic arthrit‘is, and the life-threatening CRS associated with
chimeric antigen receptor T-cell in pediatric as well as adult patients.
Tocilizumab is administered in a dose of 400mg to the COVID-19 patient.
Hypertension, gastrointestinal perforations, headaches, and skin
reactions are the significant side effects caused by tocilizumab. A dose
of 400mg given to 21 COVID-19 patients shows improvement in 91% of
patients respiratory function, and successful discharge, with only a
single dose[20]. Xu et al. reported in an FDA
phase III clinical trials of tocilizumab on patients with COVID-19 that
tocilizumab efficiently improve respiratory symptoms and decrease the
deterioration of patients. Under the supervision of IRCCS Institute
Nazionale Tumori, IRCCS, Fondazione G. Pascale of Naples, a multicenter
study on COVID-19 pneumonia is conducted on 330 patients to test the
tolerability and efficacy of tocilizumab in patients with critical
COVID-19 pneumonia[35]. To check the efficacy and
tolerability of tocilizumab, a multicentered, phase-II, open-labeled,
and single-arm clinical trial study has been initiated by the National
Cancer Institute, Naples, in treating the patient with COVID-19
pneumonia. A clinical study design to explore the use of tocilizumab in
managing COVID-19 patients with suspected pulmonary hyper inflammation
has been initiated[41]. It is a randomized,
multi-centered, open-label, and two-arm study to test the hypothesis
that virus-induced cytokine storm inflammation can be effectively
reduced by tocilizumab and results in fast recovery of clinical
condition[41]. Tocilizumab has applied
intravenously to 20 patients 400 mg once along with the necessary
anti-virus treatment. The fever of the patient returned to normal within
a few days. Oxygenation was improved by 75%. 90.5% of patients showed
a decrease in the opacity lung lesions on CT scans. In addition, In
52.6% of patients, peripheral lymphocytes count normalized. Their data
suggest that tocilizumab might prove life-saving in critical
patients[30].