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

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

rash necessitating drug discontinuation in one patient.12 Furthermore, development of a pruritic generalized cutaneous toxic erythematous rash with eosinophilia (similar to DRESS syndrome) was also reported in a SARS-CoV-2 patient receiving tocilizumab treatment.13

As cutaneous manifestations of COVID-19 and adverse dermatologic reactions of tocilizumab overlap, distinguishing disease and drug effects is imperative. Sharing and reporting cutaneous findings will be an important role of dermatologists as we deepen our understanding of novel SARS-CoV-2 manifestations. As cases of SARS-CoV-2 continue to rise, increased use of tocilizumab will require greater attention to potential cutaneous toxicity.

DISCLOSURES

Dr Dellavalle is Editor in Chief of Journal of Medical Internet Research Dermatology, a Joint Coordinating Editor for Cochrane Skin, a dermatology section editor for UpToDate, a Social Media Editor for the Journal of the American Academy of Dermatology (JAAD), and a Podcast Editor for the Journal of Investigative Dermatology (JID). He is a coordinating editor representative on Cochrane Council.

Financial Disclosure: Dr. Dellavalle receives editorial stipends (JAAD, JID), royalties (UpToDate), and expense reimbursement from Cochrane Skin. 

REFERENCES

  1. CDC. COVID Data Tracker Weekly Review. Centers for Disease Control and Prevention. Published August 27, 2021. Accessed August 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html 
  2. Pulsipher KJ, Presley CL, Szeto MD, et al. Remdesivir Use in COVID-19 Patients: Cutaneous Adverse Effect or Disease Manifestation? J Drugs Dermatol JDD. 2021;20(5):575. doi:10.36849/JDD.5777
  3. ACTEMRA® (tocilizumab) [prescribing information]. South San Francisco, CA: Genentech Inc; March 2021. Accessed September 10, 2021. https://www. gene.com/download/pdf/actrema_ prescribing.pdf 
  4. US Food and Drug Administration. Coronavirus (COVID-19) Update: FDA Authorizes Drug for Treatment of COVID-19. Published June 24, 2021. Accessed August 30, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-drug-treatment-covid-19
  5. Wei Q, Lin H, Wei R-G, et al. Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis. Infect Dis Poverty. 2021;10(1):71. doi:10.1186/s40249-021-00857-w
  6. Wilde S, Olivares KL, Nizet V, et al. Opportunistic invasive infection by group a streptococcus during anti–interleukin-6 immunotherapy. J Infect Dis. 2020;223(7):1260-1264. doi:10.1093/infdis/jiaa511
  7. Martinez-Lopez A, Cuenca-Barrales C, Montero-Vilchez T, et al. Review of adverse cutaneous reactions of pharmacologic interventions for COVID-19: A guide for the dermatologist. J Am Acad Dermatol. 2020;0(0). doi:10.1016/j. jaad.2020.08.006
  8. Inoue A, Sawada Y, Ohmori S, et al. CD30-positive Cutaneous Pseudolymphoma Caused by Tocilizumab in a Patient with Rheumatoid Arthritis: Case Report and Literature Review. Acta Derm Venereol. 2016;96(4):570-571. doi:10.2340/00015555-2309
  9. Daneshgaran G, Dubin DP, Gould DJ. Cutaneous manifestations of COVID-19: an evidence-based review. Am J Clin Dermatol. 2020;21(5):627-639. doi:10.1007/s40257-020-00558-4 
  10. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177. doi:10.1016/j. jaad.2020.03.036
  11. Catala A, Galvan-Casas C, Carretero-Hernandez G, et al. Maculopapular eruptions associated to COVID-19: a subanalysis of the COVID-Piel study. Dermatol Ther. Published online August 10, 2020:10.1111/dth.14170. doi:10.1111/dth.14170
  12. Morena V, Milazzo L, Oreni L, et al. Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy. Eur J Intern Med. 2020;76:36-42. doi:10.1016/j.ejim.2020.05.011
  13. Sernicola A, Carnicelli G, Di Fraia M, et al. "Toxic erythema" and eosinophilia associated to tocilizumab therapy in a COVID-19 patient. J Eur Acad Dermatol Venereol. Published online May 9, 2020:10.1111/jdv.16620. doi:10.1111/jdv.16620

AUTHOR CORRESPONDENCE

Robert P. Dellavalle MD PhD MSPH Robert.dellavalle@ucdenver.edu
Close Menu