托珠单抗治疗新冠肺炎联合用药的方法？

Tocilizumab combination therapy for COVID-19

Tocilizumab is the first monoclonal antibody approved by the FDA for the treatment of patients with severe COVID-19 (new coronavirus infection), providing an important option for patients hospitalized with COVID-19. Clinical trials have proven that the combination of glucocorticoids, (IL-6 receptor blockers) and baricitinib can provide additional survival benefits for patients with severe and critical COVID-19.

Tocilizumab works by mimicking natural antibodies produced by the immune system, limiting the amount of virus replication in the body. China's "New Coronavirus Pneumonia Diagnosis and Treatment Plan" (Trial Ninth Edition) recommends tocilizumab injection for treatment of severe and critical patients with elevated IL-6 levels in laboratory tests.

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The dosage of tocilizumab, an IL-6 receptor blocker, is 8 mg/kg, and the maximum dose (the limit of safe dosage) is 800 mg. The first intravenous dose should be more than 1 hour, and the second dose should be given 12-48 hours later;

Baricitinib usage and dosage:

The dosage of baricitinib, a Janus kinase inhibitor, is 6 mg/time, taken orally once a day for 14 days or until discharge.

For information on the combined use of baricitinib in the treatment of COVID-19 infection, please refer to the article:

Glucocorticoid usage and dosage:

Dexamethasone (preferred) 6 mg/time, once a day, orally or intravenously for 7-10 days;

Mepronisilone 10mg/time, once every 6 hours, intravenously for 7-10 days;

Hydrocortisone 50mg/time, 3 times a day, intravenously for 7-10 days;

Prednisone 10 mg/time, once a day, orally for 7-10 days;

The IL-6 antagonist tocilizumab can inhibit the excessive inflammatory response in critically ill patients. Early after admission, patients who receive advanced respiratory support (invasive ventilation/non-invasive ventilation/nasal high-flow oxygen therapy and FiO2 ≥ 0.4) or cardiovascular organ support (use of vasopressors or inotropes), or patients with obvious hypoxia ( When inhaling air, SpO2 <92% or requiring oxygen therapy) application of tocilizumab (400~800mg 1~2 times or 8mg/kg once) can reduce systemic inflammatory response in patients with severe systemic inflammatory response (patients with CRP275mg/L) of organ support and risk of death.

Therefore, for severe patients (levels 2 to 4) with CRP 275 mg/L, if there are no contraindications, it is recommended to apply tocilizumab 8 mg/kg 1 to 2 times (with an interval of 12 to 24 hours) within 24 hours of admission to the ICU or within 72 hours of admission to the general ward, with the maximum dose not exceeding 800 mg/time. It is recommended that patients take medication under the guidance of a doctor and receive symptomatic treatment.

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