Anti-Interleukin-6 Antibody Therapy

for Covid-19

Dr Mulyadi SpPD
Soewandhie’s Hospital
Surabaya
  Cytokine storm (typically with interleukin 6 (IL-6)
elevations) is an important cause of death in COVID-19
patients in critical and severe conditions.
 Antagonism of IL-6 elevation and inhibition of the
generation of inflammatory factor storm become an
important method for the COVID-19 treatment in
critical and severe patients.
Introduction
  Tocilizumab is a recombinant humanized anti-human
IL-6 receptor monoclonal antibody currently used to
treat adult patients with moderate-to-severe active
rheumatoid arthritis who have had an inadequate
response to DMARD.
 Therefore, tocilizumab is expected to treat COVID-19
patients in critical condition.
Introduction
  Applicable Population
 Non-applicable Population

Evaluating
Indications for
Medication
  (a) Patients confirmed with moderate NCP (including
high-risk factors for severe cases) and severe NCP
 (b) Patients aged 18–85 years
 (c) Patients with elevated IL-6 (recommended to be
tested by Roche electrochemiluminescence)
Applicable
Population

 Note: Moderate NCP (including high-risk factors for severe cases):

 Moderate NCP with bilateral pulmonary multiple lesions, or
significant progression of lesions showed on pulmonary images
>50% within 24–48 h.
  (a) Pregnant or lactating women
 (b) Patients with ALT/AST >5 times ULN, neutrophils
<0.5 × 10⁹/L, platelets <50 × 10⁹/L
 (c) Patients confirmed with rheumatoid immune disease,
malignant tumors, and other related diseases
Non-Applicable  (d) Patients orally taking anti rejection drugs or
Population immunomodulatory drugs for a long time
  (e) Patients allergic to tocilizumab or any of the
excipients
 (f) Patients with active hepatitis and tuberculosis
complicated with definite bacterial infection and fungal
infection
 (g) Organ transplant patients
Non-Applicable
 (h) Patients with mental disorders
Population
  Informed consent form must be signed by all patients
before receiving anti-human IL-6 receptor monoclonal
antibody treatment.

Signing the
Informed Consent
Form
  The initial dose is 4–8 mg/kg.
 The recommended subsequent dose is 400 mg into 100
ml of normal saline for infusion over 1 h.
 For febrile patients, it continues to be febrile after usage
within 24 h.
Use of  A second dose with the same dosage can be applied at
TocilizumabDosin an interval ≥ 12 h.
g Regimen  The maximum number of cumulative doses is twice.
 The maximum single dose is no more than 800 mg.