The Controversies Surrounding Tocilizumab Administration Following Pathogen-Associated Molecular Pattern (PAMP) Induced by COVID-19

  • Shayesteh Gheibi Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Najmeddin Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Bita Shahrami Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Kourosh Sadeghi Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Mojtaba Mojtahedzadeh Mail Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Tocilizumab, Betacoronavirus, Coronavirus Infections, COVID-19, Pathogen-Associated Molecular Pattern

Abstract

A new corona virus disease (COVID-19) is affected more than 5 million people worldwide to date and has become a global pandemic. Since there is no definitive cure for this life threatening disease, many clinical studies are underway in this regard. Pathogen-associated molecular patterns (PAMP) prompting by coronavirus seems to generate cellular, structural, and functional derangement induced by immune dysregulation and many biological abnormalities including cytokine storm. The role of IL-6 in viral pneumonia and also the impact of its inhibition on the prevention of organ damage are not known yet.IL-6 seems to behave as a double blade evil cytokine, with a valuable role in cell to cell natural physiological communication. Tocilizumab as an inhibitor of interleukin (IL)-6, may interrupt the paracrine system while causing dissemination of bacterial, fungal, and other viral infections, especially COVID-19, who are at high-risk development of sepsis and life-threatening superinfection.

References

World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization; 2020.
2. Vincent JL, editor. Intensive Care Medicine: Annual Update 2020. Brussel: Springer, Cham.; 2020.
3. Zhang X, Peck R. Clinical pharmacology of tocilizumab for the treatment of patients with rheumatoid arthritis. Expert Rev Clin Pharmacol 2011;4(5):539-58.
4. Chen KL, Lv ZY, Yang HW, et al. Effects of tocilizumab on experimental severe acute pancreatitis and associated acute lung injury. Crit Care Med 2016;44(8):e664-77.
5. Schett G. Physiological effects of modulating the interleukin-6 axis. Rheumatology 2018;57(suppl_2):ii43-50.
6. Le RQ, Li L, Yuan W, et al. FDA approval summary: tocilizumab for treatment of chimeric antigen receptor T cell‐induced severe or life‐threatening cytokine release syndrome. The oncologist 2018;23(8):943-7.
7. Jones G, Panova E. New insights and long-term safety of tocilizumab in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2018;10(10):195-199.
8. Schiff MH, Kremer JM, Jahreis A, Vernon E, Isaacs JD, van Vollenhoven RF. Integrated safety in tocilizumab clinical trials. Arthritis Res Ther 2011;13(5):R141.
9. Ali A, Na M, Svensson MN, et al. IL-1 receptor antagonist treatment aggravates staphylococcal septic arthritis and sepsis in mice. PLoS One 2015;10(7):e0131645
10. Alzghari SK, Acuña VS. Supportive treatment with tocilizumab for COVID-19: a systematic review. J Clin Virol 2020;127:104380
Published
2020-09-28
How to Cite
1.
Gheibi S, Najmeddin F, Shahrami B, Sadeghi K, Mojtahedzadeh M. The Controversies Surrounding Tocilizumab Administration Following Pathogen-Associated Molecular Pattern (PAMP) Induced by COVID-19. J Pharm Care. 8(3):140-142.
Section
Review Article(s)