May 7, 2020

Tocilizumab may have benefits in severe COVID‐19, and the incidence of both olfactory and gustatory dysfunction in COVID-19

By Denise Baez

NEW YORK -- May 7, 2020 -- In today’s DG Alert, we cover tocilizumab for the treatment of coronavirus disease 2019 (COVID-19) and the incidence of both olfactory and gustatory dysfunction in COVID-19.

According to a study published in the Journal of Medical Virology, tocilizumab was associated with radiological improvement and reduced ventilatory support requirements in patients with severe COVID-19.

Rand Alattar, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, and colleagues conducted retrospective review of 25 patients (median age, 58 years; 92% male) with laboratory‐confirmed severe COVID‐19 who received tocilizumab due to elevated CRP levels and completed 14 days of follow-up. Of the patients, 48% had diabetes. All patients received at least 2 concomitant investigational antiviral agents.

Radiological improvement was noted in 44% of patients by day 7 following initiation of treatment with tocilizumab and in 68% of patients by day 14. The proportion of patients on invasive ventilation declined from 84% at the time of tocilizumab initiation to 60% on day 7 and 28% on day 14.

The majority of patients experienced adverse events. However, the authors noted that with the exception of elevated ALT, which is known to happen with tocilizumab, it is hard to conclude which adverse events were attributable to tocilizumab and which were attributable to ribavirin or hydroxychloroquine.

Nine patients (36%) were discharged alive from the intensive care unit and 3 (12%) died.

“Notwithstanding the multitude of potential confounders in this study, it is not unreasonable to propose that this positive response may have been the result of tocilizumab’s ability to ameliorate aberrant immune response-driven pulmonary manifestation of severe COVID-19,” the authors wrote.

Another study, published in Clinical Infectious Diseases, showed that both olfactory and gustatory dysfunction is very common in patients with COVID-19, with olfactory dysfunction even levelling the symptom ‘cough’ at >70%.

“We also demonstrate that rhinitis and many of its associated symptoms (nasal congestions, sneezing, and rhinorrhoea) regularly occur in these patients, a finding that has not been reported before,” wrote Jan C. Luers, MD, University of Cologne, Cologne, Germany, and colleagues.

The researchers retrospectively analysed data from 72 patients (mean age, 38 ± 13 years) diagnosed with COVID-19 between March 22, 2020, and March 28, 2020. All patients answered a questionnaire about symptoms they experienced potentially associated with COVID-19.

Of the patients, 44 (61%) had known contact with individuals with confirmed COVID-19. The mean potential incubation time of these 44 patients was 3 ± 2 days.

The most common general symptoms included headache (78%), cough (75%), and muscle aches (71%). Diarrhoea was relatively rare (31%).

Reduced olfaction occurred in 53 (74%) patients, a reduced sense of taste was reported by 50 (69%) patients, and 49 (68%) patients reported both symptoms. Both symptoms occurred on average on the fourth day after the first symptoms had been noted. However, 9 (13%) patients noticed that reduced olfaction and loss of sense occurred together on the first day they realised any symptoms. One patient had a reduced sense of taste alone on the first day he realised any symptoms. None of the participants reported new medical treatment that could have influenced their sense of smell and taste.

Many patients had nasal congestion (54%), nasal sneezing (50%), and rhinorrhoea (53%), but nasal itching was rare (11%).

The authors acknowledged that patients were not tested for other respiratory tract pathogens and therefore other infections were not excluded. Another limitation of the study was a lack of a control group.

SOURCE: Journal of Medical Virology and Clinical Infectious Diseases