A continuación, compartimos información científica publicada recientemente sobre el uso de tocilizumab en el tratamiento de pacientes infectados por el coronavirus COVID-19.
Desde la Sociedad Española de Reumatología estamos muy pendientes del desarrollo de los acontecimientos e iremos actualizando la información conforme sea posible.
RoActemra Use in Cytokine Storm Associated with Coronavirus Diseases 2019 (COVID-19)*
*Esta información ha sido facilitada por Roche a petición del presidente de la Sociedad Española de Reumatología.
In Brief
- We are aware of preliminary case reports from various parts of the world related to the use of RoActemra for treatment of COVID-19. At present, there is no robust published clinical trialevidence evaluating the safety or efficacy related to the use of RoActemra for treatment of COVID-19. (March 9th, 2020).
- RoActemra is approved for the treatment of rheumatoid arthritis (RA), pediatric juvenile idiopathic arthritis (pJIA), systemic juvenile idiopathic arthritis (sJIA), giant cell arteritis (GCA), and chimeric antigen receptor T cell-induced cytokine release syndrome (CRS).
- Please refer to the locally approved product label for important safety information, including Warnings, Precautions, and Contraindications.
- We fully respect the clinical decision and choice of healthcare providers and medical institutions.
Abbreviations
CAR=chimeric antigen receptor IL=interleukin
COVID-19=Coronavirus Disease 2019 pJIA=pediatric juvenile idiopathic arthritis
CRS=cytokine release syndrome RA=rheumatoid arthritis arthritis
GCA=giant cell arteritis sJIA=systemic juvenile idiopathic
Background Information
High concentration of cytokines have been reported in critically-ill patients infected with COVID-19. In a Lancet publication describing 41 patients in Wuhan hospitalized for COVID-19, there was no evidence of marked IL-6 elevation.1 RoActemra was included in the 7th updated diagnosis and treatment plan for COVID-19 by the China National Health Commission. We are aware of preliminary case reports from various parts of the world related to the use of RoActemra for treatment of COVID-19.
Use in Cytokine Storms Associated with COVID-19
At present, there is no robust published clinical trial evidence evaluating the safety or efficacy of RoActemra for treatment of COVID-19, including management of cytokine storms associated
with COVID-19. (March 9th, 2020)
RoActemra is approved for the treatment of RA, pJIA, sJIA, GCA, and CAR T cell-induced CRS. The risks and benefits of treatment should be considered prior to initiating RoActemra in patients with COVID-19. Please refer to the locally approved product label for important safety information of RoActemra, including Warnings, Precautions, and Contraindications.
We fully respect the clinical decision and choice of healthcare providers and medical institutions. RoActemra Use in Cytokine Storm Associated with Coronavirus Disease 2019 (COVID-19)
References
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [supplementary appendix appears online]. Lancet 2020;395:497-506. https://www.ncbi.nlm.nih.gov/pubmed/31986264
Eculizumab
Además de tocilizumab, también hay un ensayo clínico en pacientes infectados con el coronavirus con un inhibidor de la activación del complemento, concretamente con eculizumab (anti-C5). Toda la información del estudio está localizada en el este enlace.
Otras referencias de interés:
- L He, Y Ding, Q Zhang, X Che, Y He, H Shen, HWang, Z Li, L Zhao, J Geng, Y Deng, L Yang, J Li, J Cai, L Qiu, K Wen, X Xu and S Jiang3,5. Expression of elevated levels of pro-inflammatory cytokines in SARS-CoV-infected ACE2+ cells in SARS patients: relation to the acute lung injury and pathogenesis of SARS. Journal of Pathology J Pathol 2006; 210: 288–297.
- Fei Zhou, Ting Yu, Ronghui Du, Guohui Fan, Ying Liu, Zhibo Liu, Jie Xiang, Yeming Wang, Bin Song, Xiaoying Gu, Lulu Guan, Yuan Wei, Hui Li, Xudong Wu, Jiuyang Xu, Shengjin Tu, Yi Zhang, Hua Chen, Bin Cao. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. Published Online March 9, 2020.
- Xue Zhang, Kailang Wu, Di Wang, Xin Yue, Degui Song, Ying Zhu, Jianguo Wu. Nucleocapsid protein of SARS-CoV activates interleukin-6 expression through cellular transcription factor NF-κB. Virology Journal. Available online 9 May 2007.
- Chaolin Huang, Yeming Wang, Xingwang Li, Lili Ren, Jianping Zhao, Yi Hu*, Li Zhang, Guohui Fan, Jiuyang Xu, Xiaoying Gu, Zhenshun Cheng, Ting Yu, Jiaan Xia, Yuan Wei, Wenjuan Wu, Xuelei Xie, Wen Yin, Hui Li, Min Liu, Yan Xiao, Hong Gao, Li Guo, Jungang Xie, Guangfa Wang, Rongmeng Jiang, Zhancheng Gao, Qi Jin, Jianwei Wang†, Bin Cao†. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. Published Online January 24, 2020.
- Ying Xiong, MD, Dong Sun, MD, Yao Liu, MD, Yanqing Fan, MD, Lingyun Zhao, MS, Xiaoming Li, MD, PhD, Wenzhen Zhu, MD, PhD. Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes. Investigative Radiology. Journal of clinical and laboratory research. 2020 Mar 3.
- Xiaoling Xu, Mingfeng Han, Tiantian Li, Wei Sun, Dongsheng Wang, Binqing Fu, YonggangZhou, Xiaohu Zheng, Yun Yang, Xiuyong Li, Xiaohua Zhang, Aijun Pan, Haiming Wei. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. ChinaXiv:202003.00026v1.
- Jin-jin Zhang, Xiang Dong, Yi-yuan Cao, Ya-dong Yuan, Yi-bin Yang, You-qin Yan, Cezmi A. Akdis, Ya-dong Gao. Clinical characteristics of 140 patients infected with SARSCoV-2 in Wuhan, China. Epidemiology and Genetics. Accepted: 18 February 2020.
