Tocilizumab therapy in 5 solid and composite tissue transplant recipients with early ARDS due to SARS-CoV-2.

Autor: Morillas JA; Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio., Marco Canosa F; Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio., Srinivas P; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio., Asadi T; Department of Infectious Diseases, Hillcrest Hospital, Cleveland, Ohio., Calabrese C; Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Ohio., Rajendram P; Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio., Budev M; Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.; Transplantation Center, Cleveland Clinic, Cleveland, Ohio., Poggio ED; Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.; Transplantation Center, Cleveland Clinic, Cleveland, Ohio., Narayanan Menon KV; Department of Hepatology, Cleveland Clinic, Cleveland, Ohio.; Transplantation Center, Cleveland Clinic, Cleveland, Ohio., Gastman B; Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.; Transplantation Center, Cleveland Clinic, Cleveland, Ohio., Koval C; Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.; Transplantation Center, Cleveland Clinic, Cleveland, Ohio.
Jazyk: angličtina
Zdroj: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2020 Nov; Vol. 20 (11), pp. 3191-3197. Date of Electronic Publication: 2020 Jul 22.
DOI: 10.1111/ajt.16080
Abstrakt: There are emerging data depicting the clinical presentation of coronavirus disease 19 (COVID-19) in solid organ transplant recipients but negligible data-driven guidance on clinical management. A biphasic course has been described in some infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), beginning with a flu-like illness followed by an intense inflammatory response characterized by elevated c-reactive protein (CRP), interleukin 6 (IL-6), and acute respiratory distress syndrome (ARDS) associated with high mortality. The exuberant and possibly dysregulated immune response has prompted interest in therapeutic agents that target the cytokines involved, particularly IL-6. Tocilizumab is an IL-6 receptor antagonist with a record of use for a variety of rheumatologic conditions and cytokine release syndrome due to chimeric antigen receptor T-cell therapy but experience in solid organ and composite tissue transplant recipients (SOT/CTTRs) with SARS-CoV-2-related ARDS has not been previously reported in detail. We present the clinical course of 5 SOT/CTTRs with SARS-CoV-2-related ARDS that received tocilizumab with favorable short-term outcomes in 4. Responses were characterized by reductions in CRP, discontinuation of vasopressors, improved oxygenation and respiratory mechanics, and variable duration of ventilator support. Four bacterial infections occurred within 2 weeks of tocilizumab administration. We discuss safety concerns and the need for randomized comparative trials to delineate tocilizumab's clinical utility in this population.
(© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze: MEDLINE
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