The use of tocilizumab in severe COVID-19: A comprehensive review

Abstract

This review focuses on the therapeutic application of Tocilizumab (TCZ) in the treatment of COVID-19, specifically exploring its mechanisms, safety aspects, clinical efficacy, dosing strategies, and outcomes in the Serbian context. TCZ, acting as an IL-6 receptor inhibitor, mitigates the cytokine storm observed in severe cases, leveraging its structure and pharmacokinetics. While the overall safety profile indicates good tolerability, there are subtle concerns regarding the occurrence of rare complications in critically ill patients. Clinical trials, with certain variations, emphasize the need for careful interpretation of indications and patient selection for TCZ therapy. Current protocols in place in the Republic of Serbia recommend the use of TCZ at a dose of 8 mg/kg body weight based on clinical parameters and inflammation markers, primarily IL-6 levels. Literature review suggests that during TCZ shortages, dosing may be adjusted to 400 mg as a single dose in the treatment of severe COVID-19. The optimal timing for initiating therapy coincides with the phase of increased inflammation (7-10 days after symptom onset), with an emphasis on patient selection based on biomarkers, disease severity, and the need for respiratory support. Combining TCZ with corticosteroids shows reduced mortality, necessitating cautious dosing. Potential benefits arise from combining TCZ with remdesivir, NSAIDs, and anticoagulants, requiring careful dosing and monitoring. Retrospective studies in Serbia report positive outcomes, highlighting the potential of TCZ in treating severe cases. In summary, TCZ shows promising results in the treatment of COVID-19, necessitating further research and careful patient monitoring, especially in resource-limited settings.