In a study directed and coordinated by a group of specialists in Anesthesia and Intensive Care, Infectious Diseases, Rheumatology, Pediatrics, Clinical Biochemistry and Immunology of the University of Brescia (COMETA group – acronym for COVID-MEdiated hyper-inflammaTory stAte) were the evidence of the treatment with Tocilizumab, the drug currently in use for the treatment of some autoimmune diseases, administered at the ASST Spedali Civili of Brescia to 100 patients with Covid-19 pneumonia who had developed severe and refractory respiratory failure all available treatments. This is the largest prospective series in the world of patients treated with Tocilizumab, which follows the encouraging results obtained in 20 patients in China and in the first two Italian patients treated at the Cotugno Hospital in Naples. The results of the Brescian study will be published in the prestigious Autoimmunity Reviews magazine, in the July issue.
“Our series has shown that Covid-19 pneumonia with acute respiratory distress syndrome (ARDS) is characterized by a hyperinflammatory syndrome – explains prof. Nicola Latronico of the Anesthesia and Intensive Care Unit 2 and spokesman for the study -. This series of patients treated between 9 and 20 March was analyzed to determine whether the administration of Tocilizumab, a monoclonal antibody that binds the interleukin 6 receptor, one of the mediators of inflammation that follows the immune response against the virus, could produce clinical benefits “.
At 24-72 hours and 10 days after Tocilizumab administration, improvement in acute respiratory distress syndrome was assessed using the “Brescia-COVID respiratory severity scale” (scores from 0 to 8, indicating progressive respiratory severity: https: //www.mdcalc.com/brescia-covid-respiratory-severity-scale-bcrss-algorithm): «On 100 treated patients – continues prof. Latronico – 43 received Tocilizumab in the intensive care unit, while 57 outside the intensive care unit due to unavailability of beds. Of these 57 patients, 37 (65%) improved and discontinued non-invasive ventilation, 7 (12%) patients remained stable in the intensive care unit and 13 (23%) patients worsened (10 deaths, 3 hospitalized in intensive care). Of the 43 ICU patients, 32 (74%) improved (17 were removed from artificial ventilation and transferred to the ward), 1 (2%) remained stable and 10 (24%) died (in the ” Brescia-COVID respiratory severity scale ”all had a score of ≥7 before Tocilizumab administration). Overall, at 10 days, the respiratory condition improved or stabilized in 77 patients (77%), of whom 61, during the chest X-ray examination, showed a significant reduction in lung lesions and 15 were discharged from the ‘Hospital”.
Laboratory investigations made before administering the drug have shown very high, sometimes even out of scale, levels of reactive protein C (PCR), ferritin, D-Dimer and triglycerides in all patients, confirming the hypothesis that a hyper-inflammatory syndrome was present when patients’ respiratory conditions worsened and confirming the rationale for using Tocilizumab.
Paving the way for future research, this study supports the hypothesis that the response to Tocilizumab is associated with a significant clinical improvement in patients with COVID-19 pneumonia.
The image of the comet, which gives its name to the multidisciplinary group of the study’s specialists (Laura Andreoli, Francesco Castelli, Marco Cattalini, Franco Franceschini, Emanuele Focà, Emirena Garrafa, Nicola Latronico, Simone Piva, Francesca Regola and Paola Toniati) describes the history of COVID-19 infection is good: after a first phase of viral replication and a subsequent phase of the body’s hyper-inflammatory response, the response to Tocilizumab highlights a descent of this inflammatory parabola. The study starts from the “Vademecum for the treatment of people with COVID-19 disease” from the Lombard section of SIMIT – Italian Society of Infectious and Tropical Diseases, in which many teachers and researchers from the three University Medical Departments participated. of the Brescia offices operating at the Civil Hospital of Brescia.