UK Interim Clinical Commissioning Policy for tocilizumab has been updated to cover a wider group of hospitalised COVID-19 positive patients

NHS trusts/health boards are recommended to consider prescribing single dose of tocilizumab to eligible hospitalised patients with COVID-19 pneumonia, typically as adjuvant treatment to dexamethasone as standard of care, following announcement of findings of RECOVERY trial.

SPS commentary:

RECOVERY has now reported that in hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved both 28-day survival (a relative reduction in mortality of 14%) and other clinical outcomes. These benefits were seen regardless of the level of respiratory support and were additional to the benefits of systemic corticosteroids, such as dexamethasone.

Eligible patients are defined as follows:

  • oxygen saturation of <92% on room air on repeated measurement or an ongoing requirement for supplementary oxygen AND C-reactive protein level of ≥75mg/L; OR
  • within 24 hours of starting respiratory support (high flow nasal oxygen, continuous positive airway pressure (CPAP) or non-invasive ventilation, or invasive mechanical ventilation), if an IL-6 inhibitor has not already been administered

Sarilumab continues to be recommended as a treatment option for critically ill adult patients treated with non-invasive ventilation (including high-flow nasal oxygen therapy or continuous positive airway pressure ventilation) or invasive mechanical ventilation, who have not already received tocilizumab (or other IL-6 inhibitor).

Department of Health and Social Care