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].