Official publication of Rawalpindi Medical University
Effectiveness of Tocilizumab in reducing inflammatory response associated with COVID-19 pneumonia at Islamabad Medical Complex, Islamabad

Supplementary Files



COVID-19 infection, Cytokine storm, Tocilizumab

How to Cite

Naeem A, Meraj L, Shams N, Rizvi MF, Kamal M, Amir M. Effectiveness of Tocilizumab in reducing inflammatory response associated with COVID-19 pneumonia at Islamabad Medical Complex, Islamabad. JRMC [Internet]. 2023 Apr. 1 [cited 2023 Jun. 5];27(1). Available from:


Objective: To determine the effectiveness of Tocilizumab in covid-19 related severe pneumonia.

Introduction: COVID-19 is a global health problem causing respiratory infection. This is triggered by IL-6 characterized by raised inflammatory markers that is called cytokine release storm. Severe disease leads to hospitalization, oxygen requirement and poor outcome.

Methods: This interventional study (descriptive analytic) was conducted from July-December 2021 at Intensive Care Unit, after ethical approval. Seventy cases of COVID-19 pneumonia with cytokine storm were included. Twenty cases were dropped either refusal to tocilizumab, pregnancy or having contraindication to tocilizumab, leaving 50 study participants. The patient’s demography, clinical, laboratory and radiological findings, timing and response variables of tocilizumab were recorded. The temporal readings of inflammatory markers, oxygen requirement and clinical status were compared at admission and after tocilizumab. SPSS version 25 was used for data analysis. Chi-square test was applied with significant p-value < 0.05.

Results: There was male predominance of 66% with mean age of 58.6±14.8 years. Mean day of illness and hospital stay was 8th day and 17.56 days respectively. C-reactive protein levels improved in all cases 50(100%) (p <0.0001), ferritin in 31(62%) (0.019), D dimers in 28 (56%) (p0.014), LDH in 30(60%) (p 0.02) and interleukin-6 in 32(64%) (0.017. Survival benefit with tocilizumab was significant in patients that received within 10th day of illness (p 0.021). At discharge, 66.6% were off oxygen and 33.3% required domiciliary oxygen.

Conclusion: COVID-19 Pneumonia with cytokine release storm bears high mortality. Significant improvement in inflammatory markers like CRP, ferritin, D-dimers and LDH shows effectiveness of tocilizumab. Early administration within 10 days of illness has survival benefits.


Tan LY, Komarasamy TV, Rmt Balasubramaniam V: Hyperinflammatory Immune Response and COVID- 19: A Double Edged Sword. Front. Immunol, 30: 2021, 3981

Guan WJ, Ni ZY, Hu Y, et al.: Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020, 382:1708-20

Samaee H, Mohsenzadegan M, Ala S, et al.: Tocilizumab for treatment patients with COVID- 19: recommended medication for novel disease. International immunopharmacology. 2020, 89

Sabaka P, Koščálová A, Straka I, et al.: Role of interleukin 6 as a predictive factor for a severe course of Covid- 19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC infectious diseases. 2021, 21:1-8

Zain Mushtaq M, Bin Zafar Mahmood S, Jamil B, Aziz A, Ali SA: Outcome of COVID-19 patients with use of Tocilizumab: A single center experience. Int Immunopharmacol. 2020, 88

Maes B, Bosteels C, De Leeuw, et al.: Treatment of severely ill COVID-19 patients with anti-interleukin drugs (COV-AID): A structured summary of a study protocol for a randomised controlled trial. Trials. 2020, 3:468-469

Song SN, Yoshizaki K: Tocilizumab for treating rheumatoid arthritis: an evaluation of pharmacokinetics/pharmacodynamics and clinical efficacy. Expert opinion on drug metabolism & toxicology. 20151, 11:307-16

Rosas IO, Bräu N, Waters M, et al.: Tocilizumab in hospitalized patients with severe Covid-19 pneumonia. New England Journal of Medicine. 2021, 384:1503-1516

Guaraldi G, Meschiari M, Cozzi-Lepri A, et al.: Tocilizumab in patients with severe COVID- 19: a retrospective cohort study. The. Lancet Rheumatology. 2020, 2:474-84

Calderón-Larrañaga A, Vetrano DL, Rizzuto D, Bellander T, Fratiglioni L, Dekhtyar S: High excess mortality during the COVID-19 outbreak in Stockholm Region areas with young and socially vulnerable populations. BMJ Glob Health. 2020; 5(10)3595-596

Carbonell R, Urgelés S, Rodríguez A, et al.: Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study. The. Lancet Regional Health-Europe. 2021, 11

Ul-Haq Z, Shah BH, Ardakani M, et al.: Health system preparedness in Pakistan for crisis management: a cross‐sectional evaluation study. East Mediterr Health J. 2019, 25:553-561

Saqlain M, Munir MM, Rehman SU, et al.: Knowledge, attitude, practice and perceived barriers among healthcare professionals regarding COVID‐ 19: a cross‐sectional survey from Pakistan. J Hosp Infect. 20201053, 419-423

Letelier P, Encina N, Morales P, et al.: Role of biochemical markers in the monitoring of COVID-19 patients. J Med Biochem. 2021, 40:115-128

Zeng F, Huang Y, Guo Y, et al.: Association of inflammatory markers with the severity of COVID- 19: A meta-analysis. Int J Infect Dis. 2020, 96:467-474

Hachim IY, Hachim MY, Hannawi H, Naeem KB, Salah A, Hannawi S: The inflammatory biomarkers profile of hospitalized patients with COVID-19 and its association with patient’s outcome: A single centered study. PLoS ONE. 2021, 16

Nisa A, Meraj L, Maqbool K, Ayaz I, Batool A, Shams N: Severity Index and Outcome of Hospitalized COVID-19 Patients in Capital Hospital, CDA, Islamabad. 2021, 25:126-32

Quartuccio L, Sonaglia A, Pecori D, Peghin M, Fabris M, Tascini C, De Vita S: Higher levels of IL‐6 early after tocilizumab distinguish survivors from nonsurvivors in COVID‐19 pneumonia: A possible indication for deeper targeting of IL‐6. Journal of medical virology. 2020, 92:2852-56

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2023 Abdul Naeem, Lubna Meraj, Nadia Shams, Mehr Fatima Rizvi, Muhammad Kamal, Muhammad Amir