Tocilizumab drip preferable to jab for managing COVID-19-related cytokine storm

In the treatment of cytokine storm syndrome due to the coronavirus disease (COVID-19), administering tocilizumab via the intravenous (IV) route appears to be more effective than subcutaneous (SC) therapy, leading to earlier symptom improvement and better survival, according to a study.

The retrospective analysis included 125 patients (mean age, 58 years; 33.6 percent), 65 of which received IV and 60 received SC therapy. Overall, 82 patients required supplemental oxygen and/or considered to have severe disease while 43 were on mechanical ventilation and considered to have critical illness.

Prior to treatment initiation, cytokine release syndrome criteria were grade 3 in 36 (55 percent) patients and grade 4 in 27 (42 percent) in the IV group, and in 32 (53 percent) and 26 (43 percent) patients, respectively, in the SC group.

At day 7, respiratory parameters improved in a greater proportion of patients in the IV group than in the SC group (52 percent vs 28 percent; p=0.01).

The respective 7- and 28-day mortality rates were 15 percent and 37 percent in the IV group and 17 percent and 50 percent in the SC group, with the difference not reaching statistical significance. However, in-hospital mortality rate was markedly lower in the IV group (38 percent vs 57 percent; p=0.04).

Corticosteroids were administered in >90 percent of patients in each group, but more patients in the IV group received convalescent plasma.