Negative impact of hyperglycemia on Tocilizumab therapy in COVID-19 patients

https://www.medrxiv.org/content/10.1101/2020.04.29.20076570v1

During a retrospective study on 475 Covid-19 positive patients, 78 patients with pneumonia disease and treated with tocilizumab were further evaluated for a severe outcome (encompassing both the use of mechanical ventilation and/or death). Thirty-one (39.7%) hyperglycemic and 47 (60.3%) normoglycemic Covid-19 positive patients (blood glucose levels >140 mg/dl, at admission and/or during hospital stay) were evaluated. Noteworthy, 20 (64%) of hyperglycemic and 11 (23.4%) of normoglycemic patients were also diabetics (P<0.01). Reduced effects of Tocilizumab in hyperglycemic patients may due to the higher plasma IL-6 levels. Interestingly, when authors added IL-6 levels in a Cox regression model the significance for the tocilizumab effect was lost (p<0.07). In this context, observations evidence that optimal Covid-19 infection management with tocilizumab is not achieved during hyperglycemia both in diabetic and non-diabetic patients.

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