Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia: A Randomized Clinical Trial

SPS commentary:

Two other studies are reported in conjunction.

A 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).

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.