{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:24:54Z","timestamp":1787315094274,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T00:00:00Z","timestamp":1597968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tocilizumab (TCZ) has been used in the management of COVID\u201019\u2010related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug\u2010related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID\u201019 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adult inpatients with COVID\u201019 between 1 March and 25 April\u00a02020 that received TCZ were included. We compared the rate of late\u2010onset infections (&gt;48\u2009hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post\u2010TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion\u2010related reactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred &gt;48\u2009hours after admission (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ\u2010related toxicities, 61% of patients had a possible post\u2010TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID\u201019 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jmv.26429","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T09:39:23Z","timestamp":1597311563000},"page":"1459-1464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Late onset infectious complications and safety of tocilizumab in the management of COVID\u201019"],"prefix":"10.1002","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8937-8039","authenticated-orcid":false,"given":"Natasha N.","family":"Pettit","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6khan M.","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Kimmig","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Pitrak","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Infectious Diseases and Global Health University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Pursell","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Infectious Diseases and Global Health University of Chicago Medicine  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa449"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2020.102433"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2005615117"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106043"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.25801"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2020.05.011"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102568"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2020.05.021"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2017.1316909"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102564"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6775"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30079-5"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.3204"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2004500"},{"key":"e_1_2_8_18_1","unstructured":"Tocilizumab (Actemra\u00ae) Prescribing Information. South San Francisco CA: Genentech Inc. Revised October 2013."},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-280X.1999.00247.x"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1966"},{"key":"e_1_2_8_21_1","unstructured":"National Center for Immunization and Respiratory Disease (NCIRD). Division of Viral Diseases.Evidence Used to Update the List of Underlying Medical Conditions that Increase a Persons Risk of Severe Illness from COVID\u201019.https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/evidence-table.html. 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