Tocilizumab Treatment in COVID-19 Patients: Comparing Cutaneous Disease and Adverse Drug Effects

December 2023 | Volume 22 | Issue 12 | e42 | Copyright © December 2023


Published online November 8, 2023

doi:10.36849/JDD.6532e

Angela Rosenberg BSa, Jacquelyn D. Waller PharmD BCPSb, Mindy D. Szeto MSc, Kayd J. Pulsipher BSd, Cheryl A. Bloomfield MD ODe, Colby L. Presley DOf, Robert P. Dellavalle MD PhD MSPHc,g,h

aTouro College of Osteopathic Medicine, Harlem, NY
bDepartment of Biomedical Sciences, Rocky Vista University, Parker, CO
cDepartment of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO
dCollege of Osteopathic Medicine, Rocky Vista University, Ivins, UT
eDivision of Medicine, Lehigh Valley Health Network, Allentown, PA
fDivision of Dermatology, Lehigh Valley Health Network, Allentown, PA
gDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
hDermatology Service, US Department of Veterans Affairs Rocky Mountain Regional Medical Center, Aurora, CO

Abstract
Actemra (tocilizumab) received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19) in June 2021. Literature has linked numerous cutaneous adverse effects to tocilizumab. In this current survey, investigators reviewed and compared these adverse effects to the common cutaneous manifestations of COVID-19. While similarities in patient presentation exist, important distinctions are made to aid dermatologists in their clinical diagnosis.

 J Drugs Dermatol. 2023;22(12):e42-e43.     doi:10.36849/JDD.6532e

INTRODUCTION

Over 40 million cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 2019 (COVID-19), have been reported in the United States (US).1 Pulsipher et al.2 previously compared the cutaneous manifestations of COVID-19 and adverse effects of remdesivir, an antiviral drug approved by the US Food and Drug Administration (FDA) for SARS-CoV-2.  This present survey of Actemra (tocilizumab), a recombinant humanized interleukin 6 (IL-6) receptor antagonist, aims to distinguish COVID-19 disease manifestations from adverse drug reactions.3 

Tocilizumab, FDA-approved for rheumatoid arthritis, giant cell arteritis, juvenile idiopathic arthritis, and cytokine release syndrome, received emergency use authorization for hospitalized COVID-19 patients requiring oxygen, mechanical ventilation, or extracorporeal membrane oxygenation.4 Tocilizumab may lower risk of mortality, hospital length of stay, and mechanical ventilation requirements.5 

Cutaneous changes from COVID-19 and tocilizumab are reported in the literature and summarized in Table 1. Tocilizumab adverse reactions include serious skin infections (i.e., cellulitis and necrotizing fasciitis) and cutaneous eruptions.6–8  


Maculopapular rash and urticarial lesions characterize the prominent cutaneous manifestations of COVID-19.9,10 

A cross-sectional study of tocilizumab treatment for COVID-19 reports associated morbilliform (10% of n=80) and other maculopapular (2.8% of n=36) eruptions.11 Prospective cohort analysis (n=51) similarly found a nonspecific cutaneous 
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