Tocilizumab Treatment Effect on Iron Homeostasis in Severe COVID-19 Patients

Background: Tocilizumab has been proposed as an effective treatment for severe COVID-19. We aimed to investigate whether tocilizumab administration is associated with increased availability of serum iron which may possibly be associated with adverse effects on clinical outcomes. Methods: We performed an observational, retrospective cohort study. We included adults, who were hospitalized in ICU with the diagnosis of severe COVID-19 infection eligible for tocilizumab treatment. Laboratory data including serum iron, ferritin, transferrin saturation, hemoglobin, and C-reactive protein levels of all patients were collected shortly before and 24 h, 48 h, and 72 h after tocilizumab administration. Results: During the study period, 15 patients fulfilled the inclusion criteria and were eligible to receive tocilizumab treatment. Tocilizumab therapy was associated with a prominent increase in serum iron and transferrin saturation levels (26 +/- 13 mu g/dL and 15 +/- 8% before treatment and 79 +/- 32 mu g/dL and 41 +/- 15% 72 h after treatment, respectively, p < 0.001) and decrease in serum ferritin levels (1,921 +/- 2,071 ng/mL before and 1,258 +/- 1,140 ng/mL 72 h after treatment, p = 0.027). Conclusion: Treatment of severe COVID-19 patients with tocilizumab is associated with a profound increase in serum iron and ferritin saturation levels along with a decrease in ferritin levels. This may represent an undesirable side effect that may potentiate viral replication. (c) 2022 S. Karger AG, Basel