Findings Conflicted for Benefit of Tocilizumab in COVID-19
FRIDAY, Oct. 23, 2020 -- Tocilizumab may be beneficial for adults with COVID-19 admitted to the intensive care unit (ICU), although other findings are conflicting, according to three studies and an editorial published online Oct. 20 in JAMA Internal Medicine.
Shruti Gupta, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues analyzed data from 3,924 adults with COVID-19 admitted to ICUs at 68 U.S. hospitals; 11 percent received tocilizumab in the first two days. The researchers found that 1,544 patients died (39.3 percent), including 125 treated with tocilizumab and 1,419 not treated with tocilizumab (28.9 versus 40.6 percent). During a median follow-up of 27 days, the risk for death was lower for patients treated with versus those not treated with tocilizumab (hazard ratio, 0.71; 95 percent confidence interval, 0.56 to 0.92).
Carlo Salvarani, M.D., from Azienda USL-IRCCS di Reggio Emilia in Italy, and colleagues examined the effect of early tocilizumab administration versus standard therapy for preventing clinical worsening in 123 patients hospitalized with COVID-19 pneumonia. The researchers found that 28.3 and 27 percent randomly assigned to tocilizumab and standard care, respectively, showed clinical worsening within 14 days since randomization (rate ratio, 1.05; 95 percent confidence interval, 0.59 to 1.86). In a third study, Olivier Hermine, M.D., from the Hôpitaux de Paris, and colleagues randomly assigned patients with COVID-19 and moderate or severe pneumonia to tocilizumab plus usual care or usual care alone (63 and 67 patients, respectively) and found that 12 and 19 patients had a World Health Organization Clinical Progression Scale score greater than 5 on day 4 (median posterior absolute risk difference, −9 percent; 90 percent credible interval, −21 to 3.1).
"Newly released randomized trials suggest a potential role for tocilizumab in COVID-19 but do not show clear evidence of efficacy, in contrast to observational studies," writes the author of an accompanying editorial.
Several authors from the Gupta and Salvarani studies and one author from the Hermine study disclosed financial ties to the biopharmaceutical industry.
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Posted: October 2020
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