Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19
Cohort study (n=3,924) found those treated with tocilizumab had a lower risk of death vs those not given tocilizumab (HR 0.71, 95%CI 0.56-0.92 after median follow up of 27 days). 30 day mortality was 27.5% for tocilizumab vs 37.1% for no tocilizumab (p<0.05).
Source:
JAMA Internal Medicine
Resource links:
RCT of tocilizumab on rate of disease progression in hospitalised COVID-19 patients
RCT of tocilizumab in COVID-19 and moderate or severe pneumonia:
SPS commentary:
Two RCTs are reported in conjunction.
One RCT investigating use of tocilizumab in COVID-19 and moderate or severe pneumonia (n=131) found that tocilizumab did not improve the rate of reduction of the WHO Clinical Progression Scale score to <5 vs placebo, however fewer patients needed noninvasive or mechanical ventilation or died (24% vs 36%, HR 0.58, 90%CI 0.33-1.00).
A separate RCT investigating the efficacy of tocilizumab on the rate of disease progression in hospitalised COVID-19 patients found that tocilizumab did not reduce the rate of disease progression (entry to ICU, requirement for mechanical ventilation, death or significant worsening of Pao2/Fio2 ratio) vs placebo in patients with COVID-19 pneumonia and Pao2/Fio2 ratio between 200 and 300 mm Hg.
A related editorial discusses implications of these studies, as well as preliminary results from two other multicenter, randomised, double-blind, placebo-controlled trials investigating the use of tocilizumab in COVID-19 (COVACTA12 and EMPACTA) . It concludes, that despite some positive endpoints, findings from the randomised trials do not support routine tocilizumab use in COVID-19. Differences in mortality attributable to tocilizumab at day 28 or 30 were not observed across all randomised trials, and only 2 of the 4 trials reported evidence of efficacy, one based on a single primary outcome measure that barely met its predefined efficacy threshold. Although observational studies report mortality benefit and other positive outcomes, priority should be given to the randomized trial results when developing clinical algorithms.