Spinal cord disorder found in Covid patients given Tocilizumab, study says

Three patients were observed in the study and all of them were given Tocilizumab. Of them, one developed a rare spinal cord disorder.

Representational image | T Narayan | Bloomberg

New Delhi: Researchers in Italy have flagged spinal cord dysfunction in some patients who suffered from Covid-19 infection, according to the latest report published in popular science journal Nature.

The authors of the report, published Wednesday, observed three individuals affected by spinal cord dysfunction (SCD) after suffering from Covid. The report was authored by seven Milan-based researchers.

While the trend was not noticed on a large sample but the aim of the report, the authors claimed, “is to provide our initial experience with individuals experiencing SCD after Covid-19 in a referral centre in Northern Italy from 21 February to 15 July 2020”.

The researchers claimed that “to our knowledge, this is the first report of SCD after Covid-19.”

“Considering the impact of SCD on quality of life and national healthcare systems, we advocate the collection and sharing of data regarding individuals with SCD after Covid-19,” the researchers said. 

Prior to developing the spinal cord issues, the three individuals suffered from respiratory failure due to Covid, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received Tocilizumab.

While no direct relationship between Covid and spinal cord disease was established, the researchers pointed that all three patients were given Tocilizumab (TCZ) and other immunomodulatory therapy (IMT) drugs, including corticosteroids that may cause serious side-effects. Immunomodulatory drugs regulate the body’s immune system.

Tocilizumab, role of other drugs questioned by researchers 

The researchers clarified that “based on our experience, we did not observe a direct viral infection, but there were two different etiologies”.

Among the three Covid patients who reported SCD, one developed spinal cord ischemia, a rare but severe condition whose treatment is not well-known. The other two suffered from Spinal Epidural Abscess (SEA), which is likely related to the use of Tocilizumab to treat Covid-19, the report claimed.

“… We did not observe a SARS-CoV-2 infection of the spinal cord provoking a direct injury,” the report said.

“During the initial period of the Covid-19 emergency, we experienced the release of weekly hospital protocols. Indeed, some drugs were not shared among the included cases. However, Tocilizumab was a constant in 3/3 cases.” 

Following the initial success, Tocilizumab became freely available in Italy, researchers claimed. 

“Among TCZ potential adverse effects, abscesses in different body parts had been reported over the years,” the researchers said, quoting previous studies.  

Abscess is a condition where pus gets collected within the tissue of the body. 

Researchers believe that these abscesses may have been precipitated by the immunomodulatory therapy, which were administered to treat SARS-CoV-2 infection. 

“In general, IMT (eg, corticosteroids, thiopurines, methotrexate, calcineurin inhibitors, and antitumor necrosis factor agents) may favour infections. Therefore, the combination of Covid-19 and IMT might provoke abscesses, like the described spinal epidural abscess,” the study said.