Treatment of Serious and Critical Patients With COVID-19 With Tocilizumab

In December 2019, a group of patients with the acute respiratory disease was detected in Wuhan, Hubei Province of China. A month later, a new beta-coronavirus was identified as the cause of the 2019 coronavirus infection. Despite China's efforts to contain the disease, it spread rapidly outside the continent. Currently, Mexico is one of the countries that is facing this world health problem with a dynamic and exponential increase in the number of confirmed cases.

SARS-CoV-2 is a coronavirus that belongs to the group of β-coronaviruses of the subgenus Coronaviridae. The SARS-CoV-2 is the third known zoonotic coronavirus disease after severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS). The diagnosis of SARS-CoV-2 recommended by the WHO, CDC is the collection of a sample from the upper respiratory tract (nasal and oropharyngeal exudate) or from the lower respiratory tract such as expectoration of endotracheal aspirate and bronchioloalveolar lavage and its analysis using the test of real-time polymerase chain reaction (qRT-PCR).

The clinical manifestations of the patients are heterogeneous presenting asymptomatic symptoms, mild respiratory disease, severe pneumonia, acute respiratory failure syndrome (ARDS), and even death. According to the Berlin definition, ARDS is an acute lung injury that occurs within 7 days after the triggering event and is characterized by bilateral lung infiltrates and severe progressive hypoxemia, as well as non-cardiogenic pulmonary edema. The mortality associated with ARDS depends on its severity: mild 27%, moderate 32%, and severe 45%. In patients with SARS and SARS-CoV-2, the average duration of mechanical ventilation was reported in 10 (7-12) days, achieving extubation in 6/18 (33%) of which their meantime under mechanical ventilation was 11 (7-12) days. Of these patients, none received treatment with tocilizumab, only 1 patient received hydroxychloroquine, and another patient was treated with lopinavir-ritonavir. Therefore, the present study proposes that the use of Tocilizamab will shorten the time to improve, so an evaluation of the ARDS will be carried out at 7 days.

Initial reports suggest that SARS-CoV-2 is associated with a severe illness that requires the intensive care unit in approximately 5% of confirmed infections. In the CDC report from China, the clinical manifestations of the disease were divided into:

Mild: Mild respiratory symptoms (cough, malaise, temperature> 37.5, runny nose) with or without pneumonia data by an imaging study (up to 81% cases) Severe: dyspnea, increase in respiratory rate ≥ 30 breaths / min, oxygen saturation ≤ 93%, PaO2 / FiO2 <300 mmHg, and image lung infiltrates> 50% within 24 to 48 hours of symptom onset (up to 14 % of the cases) Critical: respiratory failure, septic shock and/or multiple organ failure (up to 5% of cases)