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Tocilizumab therapy in 5 solid and composite tissue transplant recipients with early ARDS due to SARS‐CoV‐2
Author(s) -
Morillas Jose A.,
Marco Canosa Francisco,
Srinivas Pavithra,
Asadi Tannaz,
Calabrese Cassandra,
Rajendram Prabalini,
Budev Marie,
Poggio Emilio D.,
Narayanan Me K. V.,
Gastman Brian,
Koval Christine
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16080
Subject(s) - tocilizumab , medicine , cytokine release syndrome , ards , immunology , discontinuation , anakinra , lung , immune system , disease , chimeric antigen receptor , t cell
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.