Early-onset fever tied to more severe cytokine release syndrome, multiple tocilizumab doses

“Prompt and aggressive tocilizumab treatment could be protective against the negative consequences of cytokine release syndrome,” the authors said.

Twenty-eight patients treated with tocilizumab for cytokine release syndrome secondary to immune effector cell therapy were included in this retrospective single-institution analysis. The authors categorized patients into early tocilizumab (within 24 h from fever onset) or late tocilizumab groups (>24 h from fever onset).

Glucocorticoid use, intensive care unit admission, or inpatient mortality was the composite primary outcome. Secondary outcomes were as follows: comparing the various presentations of cytokine release syndrome, need for vasopressors, length of stay, rates of neurotoxicity, and C-reactive protein and ferritin trends.

Fever onset was earlier (35 vs 113 h; p=0.017) and maximum cytokine release syndrome grade was higher (median, grade 2 vs grade 1; p=0.025) among patients in the early vs late tocilizumab group. In addition, the early tocilizumab group required more doses of the study drug (median, 2 vs 1; p=0.037).

Interestingly, the primary composite outcomes did not differ statistically between groups despite the difference in cytokine release syndrome presentation.

“Anti-IL-6 therapy …  is the standard treatment for cytokine release syndrome since it reverses symptoms without compromising immune effector cell therapy efficacy,” the authors said.

“Glucocorticoids are reserved for refractory or severe cytokine release syndrome due to concern for attenuating antitumour activity. Optimizing the timing of tocilizumab could avoid glucocorticoid use and improve outcomes,” they added.