Late Onset Infectious Complications and Safety of Tocilizumab in the Management of COVID-19

BACKGROUND: Tocilizumab (TCZ) has been used in the management of COVID-19-related cytokine release syndrome (CRS) Concerns exist regarding the risk of infections and drug-related toxicities We sought to evaluate the incidence of these TCZ complications among COVID-19 patients METHODS: All adult inpatients with COVID-19 between March 1(st) and April 25(th) , 2020 that received TCZ were included We compared the rate of late-onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement Post-TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion-related reactions RESULTS: Seventy-four patients were included in each group Seven-teen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (p=0 013) Most infections were bacterial with pneumonia being the most common manifestation Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1 4%, and hypertension in 8% The mortality rate among those that received TCZ was greater than the control (39% versus 23%, p=0 03) CONCLUSION: Late onset infections were significantly more common among those receiving TCZ Combining infections and TCZ-related toxicities, 61% of patients had a possible post-TCZ complication While awaiting clinical trial results to establish the efficacy of TCZ for COVID-19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use This article is protected by copyright All rights reserved