CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab: foreign literature review
V. I. Stashkiv,
K. A. Zamyatina,
M. Yu. Shantarevich,
I. V. Nikitina,
G. G. Kаrmаzаnovsky,
A. Sh. Revishvili https://doi.org/10.24835/1607-0763-2020-2-96-97
Abstract
Purpose. Review and analysis of the available foreign literature about CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab.
Material and methods. 6 publications were analyzed that were available for the keywords “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6”. Search was limited only to English language manuscripts with no time limit. The literature search was last done on 3rd June 2020.
Results. There is a small number of studies on CT findings of COVID-19 pneumonia during the treatment of actemra (tocilizumab). At the request of “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6” in the database of medical and biological publications “PubMed” on 03.06.2020 can be found only 8 publications that would satisfy the search query. At the time of writing this article we were able to locate only 1 full text articles in English which was the study of CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab. It is important to note that new data is being shared regularly and so far, it consists mostly of pre-prints, case reports, small case series.
Conclusion. After analyzing the available literature, it can be concluded that the majority of authors confirm the positive effect associated with taking tocilizumab, as evidenced by a very rapid improvement in the condition of patients, however, the CT-findings often does not correlate with the clinical course of the disease and does not always show improvement in lung tissue, which should not be regarded as negative dynamics, but as a natural regression of pathological changes in lung tissue.
About the Authors
V. I. Stashkiv
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Vladislava I. Stashkiv – Resident
117997, Moscow, Bolshaya Serpukhovskaya str., 27
K. A. Zamyatina
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Kseniia A. Zamyatina – Resident
117997, Moscow, Bolshaya Serpukhovskaya str., 27
M. Yu. Shantarevich
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Mariia Yu. Shantarevich – Resident
117997, Moscow, Bolshaya Serpukhovskaya str., 27
I. V. Nikitina
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Irina V. Nikitina – Resident
117997, Moscow, Bolshaya Serpukhovskaya str., 27
G. G. Kаrmаzаnovsky
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Grigory G. Kаrmаzаnovsky – Corresponding member of the Russiаn Асаdemy of Sсienсes, Dr. of Sci. (Med.), Professor, Heаd of X-ray and magnetic resonance studies department with ultrasound; Professor of radiology department
117997, Moscow, Bolshaya Serpukhovskaya str., 27
A. Sh. Revishvili
A.V. Vishnevsky Medical Research Center of Surgery the Ministry of Health of the Russian Federation of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Amiran Sh. Revishvili – Academician of the Russian Academy of Science, Dr. of Sci. (Med.), Professor, Director
117997, Moscow, Bolshaya Serpukhovskaya str., 27
References
1. Fu L., Wang B., Yuan T., Chen X., Ao Y., Fitzpatrick T., Li P., Zhou Y., Lin Y.F., Duan Q., Luo G., Fan S., Lu Y., Feng A., Zhan Y., Liang B., Cai W., Zhang L., Du X., Li L., Shu Y., Zou H. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and metaanalysis. J. Infect. 2020; 80 (6): 656–665. https://doi.org/10.1016/j.jinf.2020.03.041.
2. WHO main website. http://www.euro.who.int/ru/healthtopics/health-emergencies/coronavirus-covid-19 (accessed March 12, 2020)
3. Radiology of coronavirus disease (COVID-19): organization, methodology, interpretation of results. Preprint No. CDT – 2020 – II Version 2 (17.04.2020). Text: electronic. (In Russian)
4. Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19 [published online ahead of print, 2020 Mar 28]. Int. J. Antimicrob. Agents. 2020. https://doi.org/10.1016/j.ijantimicag.2020.105955
5. Temporary guidelines for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19), Ministry of Health of the Russian Federation version 6 of 28.04.2020. (In Russian)
6. Li Y., Xia L. Coronavirus Disease 2019 (COVID-19): role of chest CT in diagnosis and management. Am. J. Roentgenol. 2020; 214 (6): 1280–1286. https://doi.org/10.2214/AJR.20.22954
7. https://www.rosminzdrav.ru/ministry/med_covid19 Recommendations for doctors on Covid-19 of the Ministry of Health of the Russian Federation.
8. Chen J. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19. 2020; 10 (Google Scholar)
9. Li Y., Xie Z., Lin W., Cai W., Wen C. et al. An exploratory randomized controlled study on the efficacy and safety of lopinavir/ritonavir or arbidol treating adult patients hospitalized with mild/moderate COVID-19 (ELACOI). [online]. Website https://www.medrxiv.org/content/10.1 101/2020.03.19.20038984v2 [accessed 12 April 2020].
10. Young B.E., Ong S.W.X., Kalimuddin S., Low J.G., Tan S.Y. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020; 10 [PMC free article] [PubMed] [Google Scholar]
11. Chen C.Y., Wang F.L., Lin C.C. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin. Toxicology. 2006; 44: 173– 175. https://doi.org/10.1080/15563650500514558
12. Borba M.G.S., De Almeida Val F., Sampaio V.S., Araújo Alexandre M.A., Melo G.C. et al. Chloroquine diphosphate in two different dosages as adjunctive therapy ofhospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: preliminary safety results of a randomized, doubleblinded, phase IIb clinical trial (CloroCovid-19 Study) [online]. (2020). https://www.medrxiv.org/content/10.11 01/2020.04.07.20056424v2 [accessed 12 April 2020]
13. Chorin E., Dai M., Shulman E., Wadhwani L., Cohen R.B. et al. The QT interval in patients with SARS-CoV-2 infection treated with hydroxychloroquine/azithromycin [online]. 2020. https://www.medrxiv.org/content/10.1101/2020.0 4.02.20047050v1 [accessed 12 April 2020].
14. Mehra M.R., Desai S.S., Ruschitzka F., Patel A.N. RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 May 22: S0140-6736(20)31180-6. https://doi.org/10.1016/S0140-6736(20)31180-6. Epub ahead of print. Erratum in: Lancet. 2020 May 30: PMID: 32450107; PMCID: PMC7255293.
15. Ministry of Health of the Russian Federation “On the use of the drug Hydroxychloroquine for the treatment of patients with coronavirus infection” dated May 28, 2020. https://www.rosminzdrav.ru/news/2020/05/28/14067-oprimenenii-preparata-gidroksihlorohin-dlya-lecheniyapatsientov-s-koronavirusnoy-infektsiey
16. Chu C.M., Cheng V.C., Hung I.F.N., Wong M.M., Chan K.H. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004; 59: 252–256. https://doi.org/10.1136/thorax.2003.012658
17. Ye X.T., Luo Y.L., Xia S.C., Sun Q.F., Ding J.G., Zhou Y., Chen W., Wang X.F., Zhang W.W., Du W.J., Ruan Z.W., Hong L. Clinical efficacy of lopinavir/ritonavir in the treatment of Coronavirus disease 2019. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (6): 3390–3396. https://doi.org/10.26355/eurrev_202003_20706. PMID: 32271456.
18. Assessment Report For RoActemra [Internet] 1st ed. London: European Medicines Agency; 2009. [accessed 2017January3]. http://www.ema.europa.eu/docs/en_ GB/document_library/EPAR_-_Public_assessment_ report/human/000955/WC500054888.pdf
19. https://www.roche.ru/content/dam/rochexx/roche-ru/roche_russia/ru_RU/Instructions/actemra-iv-2019-12-30.pdf Версия 10 МИНЗДРАВ РОССИИ ЛСР-003012/09-301219
20. Higuchi T., Nakanishi T., Takada K., Matsumoto M., Okada M., Horikoshi H., Suzuki K. A case of multicentric castleman's disease having lung lesion successfully treated with humanized anti-interleukin-6 receptor antibody, Tocilizumab. J. Korean Med. Sci. 2010; 25 (9): 1364–1367. https://doi.org/10.3346/jkms.2010.25.9.1364. PMID:20808682.
21. FDA approves tisagenlecleucel for B-cell ALL and tocilizumab for cytokine release syndrome. https://www. fda.gov/drugs/resources-information-approved-drugs/fda-approves-tisagenlecleucel-b-cell-all-andtocilizumab-cytokine-release-syndrome
22. Moore J.B., June C.H. Cytokine release syndrome in severe COVID-19. Science. 2020; 368 (6490): 473–474. https://doi.org/10.1126/science.abb8925
23. Le R.Q., Li L., Yuan W., Shord S.S., Nie L., Habtemariam B.A., Przepiorka D., Farrell A.T., Pazdurb R. Tocilizumab for Treatment of Chimeric Antigen Receptor T Cell-Induced Severe or Life-Threatening Cytokine Release Syndrome. Oncologist. 2018; 23 (8): 943–947. https://doi.org/10.1634/theoncologist.2018-0028
24. Yuan J., Zou R., Zeng L. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients. Inflamm. Res. 2020 Mar 29: 1–8. https://doi.org/10.1007/s00011-020-01342-0
25. Zhang C., Wu Z., Li J.W., Zhao H., Wang G.Q. The cytokine release syndrome (CRS) of severe COVID-19 and Inter leukin-6 receptor (IL-6R) antagonist tocilizumab may be the key to reduce the mortality. Int. J. Antimicrob. Agents. 2020:105954. https://doi.org/10.1016/j.ijantimicag.2020.105954.
26. Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of 2019 novel coronavirus infection in China. Med. Rxiv. 2019;2020:2020. https://doi.org/10.1101/2020.02.06.20020974
27. https://www.rosminzdrav.ru/ministry/med_covid19
28. Cellina M, Orsi M, Bombaci F, Sala M, Marino P, Oliva G. Favorable changes of CT findings in a patient with COVID-19 pneumonia after treatment with tocilizumab. Diagn. Interv. Imaging. 2020; 101 (5): 323–324. https://doi.org/10.1016/j.diii.2020.03.010.
29. Xu X., Han M., Li T., Sun W., Wang D., Fu B., Zhou Y., Zheng X., Yang Y., Li X., Zhang X., Pan A., Wei H. Effective Treatment of Severe COVID-19 Patients With Tocilizumab. Proc. Natl. Acad. Sci. USA. 2020; 117 (20): 10970–10975. https://doi.org/10.1073/pnas.2005615117
30. Michot J.-M., Albiges L., Chaput N., Saada V., Pommeret F., Griscelli F., Balleyguier C., Besse B., Marabelle A., Netzer F., Merad M., Robert C., Barlesi F., Gachot B., Stoclin A. Tocilizumab, an anti-IL-6 receptor antibody, to treat COVID-19-related respiratory failure: a case report. Ann. Oncol. 2020 Apr 2: S0923-7534(20)36387-0. https://doi.org/10.1016/j.annonc.2020.03.300
31. Wang L., Peng X., Wang Z.-H., Cai J., Zhou F.-C. Tocilizumab in the treatment of a critical COVID-19 patient: a case report. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (10): 5783–5787. https://doi.org/10.26355/eurrev_202005_21372
32. Mihai C., Dobrota R., Schröder M., Garaiman A., Jordan S., Becker M.O., Maurer B., Distler O. COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD. Ann. Rheum. Dis. 2020; 79 (5): 668–669. https://doi.org/10.1136/annrheumdis-2020-217442
33. The first affiliated hospital of university of science and technology. The efficacy and safety of tocilizumab in the treatment of novel coronavirus pneumonia: a multi-center, randomized, double-blinded trial. 2020. https://www. chictr.org.cn/showproj. aspx?proj=49409. Accessed 22 Feb 2020.
Review
For citations:
Stashkiv V.I., Zamyatina K.A., Shantarevich M.Yu., Nikitina I.V., Kаrmаzаnovsky G.G., Revishvili A.Sh. CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab: foreign literature review. Medical Visualization. 2020;24(2):96-104. (In Russ.) https://doi.org/10.24835/1607-0763-2020-2-96-97
Views:
1029
Email this article 