Coronavirus: Tocilizumab Injection in treatment of coronavirus (COVID-19)

The cytokine-targeted biological therapies can improve out come in CRS (Cytokine Release Syndrome) or MAS (Macrophage Activation Syndrome) and even in sepsis. Tocilizumab an anti-IL-6R biological therapy, has been approved for treatment of CRS and used in the patients with MAS. Based on these data, it is hypothesized that Tocilizumab can reduce mortality in patients with severe COVID-19 prone to CRS and ARDS (Acute Respiratory Distress Syndrome)



The respiratory syndrome by Coronavirus first discovered in December 19 in china (Wuhan) is causing a worldwide pandemic with potentially lethal implications on individual basis, and on the large scale brining the health care system to its limits. The mortality rate of this coronavirus COVID-19 has been estimated by world health organization (WHO) to be 3.7% which is more than 10 fold higher than the mortality of influenza 

How coronavirus effect the Respiratory system 
Coronavirus can affect the upper respiratory system (nose, sinuses and throat) by causing flu-like symptoms, the lower respiratory system (airways and lungs) by causing cough with or without mucous and difficulty breathing. When COVID-19 is severe it can bring on pneumonia or acute respiratory distress syndrome (ARDS) 

ARDS host immune response 
An infection with coronavirus may cause an excessive host immune response, leading to an Acute Respiratory Distress Syndrome (ARDS) and death an overwhelming inflammation which is triggered by virus, causing a cytokine storm with a features of cytokine Release Syndrome (CRS) or Macrophage Activation syndrome (MAS). Pro -inflammatory cytokines such as interleukin-6(IL-6) are elevated in the plasma of patients and features of MAS in COVID-19 include elevated levels of ferritin, d-dimer and low platelets.

There is increasing evidence, that cytokine-targeted biological therapies can improve outcomes in CRS or MAS and even in sepsis. In recognition of the dramatic development of COVID-19 pandemic, and in a pragmatic manner, already approved and safe therapies should be evaluated for the use in severe COVID-19

Tocilizumab Mechanisms Of Action
Interleukin 6 (IL-6) is involved in the development of immunological and inflammatory reactions. Some autoimmune diseases like RA are associated with abnormally high IL-6 levels. Tocilizumab binds soluble as well as membrane bound interleukin-6 receptors, hindering IL-6 from exerting it's pro- inflammatory effects. It has been noted that the membrane bound from and soluble form of the IL-6 receptors may have different effects in the pathogenesis of rheumatoid arthritis with the soluble form being more implicated in diseases progression
Tocilizumab, an anti-IL-6R biological therapy has been approved for the treatment of CRS and is used in patients with MAS 
Collectively, the data strongly suggest that neutralizing of the inflammatory pathway induced by IL-6 may reduce mortality in patients with severe COVID-19 prone to CRS and ARDS.

Doses of Tocilizumab Injection 
Tocilizumab Injection is given intravenously.
Patient get one dose (=8mg/kg bodyweight, max. Single dose 800mg) intravenously in 100 ml Nacl 0.9% after confirmation of progressive dyspnea. Infusion time: 60 min. 
The procedure is repeated once if no clinical improvement in 8-point WHO scale is observed.

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