eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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vol. 15
Letter to the Editor

Effective treatment of severe acute pancreatitis and COVID-19 pneumonia with tocilizumab

Piotr Zielecki
Magdalena Kaniewska
Mariusz Furmanek
Tomasz Bulski
Grażyna Rydzewska
1, 3

Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
Department of Radiology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
Gastroenterology Rev 2020; 15 (3): 267–272
Online publish date: 2020/09/19
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In December 2019 the coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was reported for the first time in Wuhan, China [1], and it subsequently rapidly spread to the rest of the world. On 11th March 2020 COVID-19 was declared a pandemic by the World Health Organisation [2]. The most common symptoms are fever, cough, shortness of breath, fatigue, myalgia, and loss of smell and taste [3], but gastrointestinal symptoms like vomiting, diarrhoea, and abdominal pain are also reported [4, 5]. SARS-CoV-2 uses angiotensin-converting enzyme (ACE) 2 as an entry receptor to infect host cells [6]. The highest ACE 2 expression was found in alveolar cells of the lungs [7], but also in the heart, kidneys, and gastrointestinal tract, including the pancreas. To date, it is not known if SARS-CoV-2 can cause pancreatic cell damage leading to acute pancreatitis, but in many cases serum lipase and amylase levels are elevated [8]. A study also showed that patients with history of acute pancreatitis may be more susceptible to COVID-19, but the mechanism of this phenomenon is not known yet [9]. Many severe COVID-19 patients develop acute respiratory distress syndrome (ARDS), which is the most serious complication of SARS-CoV-2 infection [10]. It has been reported that a systemic inflammatory syndrome called cytokine release syndrome (CRS) is responsible for the development of ARDS in SARS-CoV-2 infection, which leads to pulmonary fibrosis and organ failure. In this pathophysiological process interleukin-6 (IL-6), and B and T cells play key roles [11]. Tocilizumab (TCZ) is a monoclonal antibody that competitively inhibits the binding of IL-6 to its receptor (IL-6R). This mechanism blocks receptor complex signal transduction to inflammatory mediators responsible for B and T cell activation and inhibits cytokine storm [12]. IL-6 pathway blocking can be a new method for the treatment of severe COVID-19 patients [13], and tocilizumab is expected to become an effective drug against COVID-19, but currently scientific data are limited. One study showed that TCZ might reduce mortality in patients with severe COVID-19 pneumonia [14], but to date there have been no human studies evaluating tocilizumab in the treatment of acute pancreatitis. U.S. Food and Drug Association (FDA)-approved phase III randomised controlled trials on tocilizumab are ongoing [15]. We report the first (to date) case study of a patient with severe acute pancreatitis and COVID-19 pneumonia treated effectively with tocilizumab.
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