{"id":38523,"date":"2020-07-22T07:22:24","date_gmt":"2020-07-22T07:22:24","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=38523"},"modified":"2020-07-24T07:31:20","modified_gmt":"2020-07-24T07:31:20","slug":"further-studies-report-positive-outcomes-from-using-tocilizumab-to-treat-covid-19","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38523","title":{"rendered":"Further positive reports from tocilizumab to treat COVID-19"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n

Two new publications provide additional reports of positive outcomes from using the anti-IL-6 monoclonal antibody tocilizumab to treat COVID-19.<\/strong><\/p>\n

The largest of these is a retrospective analysis of 544 patients hospitalised with severe COVID-19. Results were reported by Giovanni Guaraldi from University of Modena on 24 June in Lancet Rheumatology. [1]<\/p>\n

Median age was 67 years (IQR: 56 to 77) and 359 (66%) men, with more severe baseline characteristics in participants who received tocilizumab.<\/p>\n

Overall, 179\/544 participants received open-label tocilizumab and 365\/544 received standard of care. Of these, a similar percentage progressed to need mechanical ventilation: 57 (16%) vs 33 (18%), p=0.41, for the SoC and tocilizumab groups respectively. These results were similar for both intravenous (n=88) and subcutaneous (n=91) formulations of tocilizumab.<\/p>\n

However, mortality was significantly higher in people just receiving SoC: 73 (20%) vs 13 (7%) in SoC vs tocilizumab, p<0\u00b70001).<\/p>\n

In multivariate analysis, adjusting for sex, age, recruiting centre, duration of symptoms, and SOFA score, tocilizumab was associated with a significantly reduced risk of invasive mechanical ventilation or death (adj. HR 0\u00b761, 95% CI: 0.40 to 0.92; p=0\u00b7020).<\/p>\n

Tocilizumab was also associated with significantly fewer new infections: 24\/179 (13%) vs 14\/365 (4%), p<0\u00b70001).<\/p>\n

The second report was from an observational US cohort of 27 people hospitalised with SARS-CoV-2 pneumonia <\/span>who received tocilizumab. Median age was 63 years (IQR: 51 to 75 years) and 23\/27 were men. Seventeen patients (63%) had a significant comorbidity, including hypertension in 12\/17. [2]<\/span><\/p>\n

Participants received a 400 mg intravenous dose of tocilizumab as part of a compassionate access programme at a single site in Los Angeles. Participants also received hydroxychloroquine and azithromycin, with 7\/27 on blinded placebo-controlled remdesivir study.<\/p>\n

At baseline, all participants were already receiving oxygen support with oxygen levels <90%, with most (21\/27) on mechanical intubation. All showed IL-6 as the predominant cytokine.<\/p>\n

Although tocilizumab was associated with significant rapid reductions in temperature and CRP, 4\/27 showed no response, and 3\/4 progressed with poorer outcomes. The paper discussed whether the non-responses might have been different with higher dosing.<\/p>\n

Two deaths, at days 3 and 11, were not judged to be linked to tocilizumab.<\/p>\n

The report concluded that these results were significantly better than historical reports with hypothetical mechanism for reducing elevated IL-6 that is associated with severe COVID-19 and poor prognosis.<\/p>\n

comments<\/span><\/h3>\n

Although small retrospective analyses, these results add to the growing number of studies that have reported potentially positive results with tocilizumab.\u00a0<\/strong>Four earlier studies were reviewed in a recent earlier issue of HIV and COVID-19. [3]<\/strong><\/p>\n

Many other prospective studies are already ongoing, including the large UK RECOVERY study, using a randomised design. [4]<\/strong><\/p>\n

Based on limited success with all approaches based on monotherapy, combination approaches should be prioritised, with at least one study already using tocilizumab plus remdesivir. [5]<\/strong><\/p>\n

References<\/span><\/p>\n

    \n
  1. Guaraldi G et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. The Lancet Rheumatology, DOI: 10.1016\/S2665-9913(20)30173-9. (24 June 2020).
    \n<\/span>https:\/\/www.thelancet.com\/journals\/lanrhe\/article\/PIIS2665-9913(20)30173-9<\/span><\/a><\/li>\n
  2. Jordan SC et al. Compassionate use of tocilizumab for treatment of SARS-CoV-2 pneumonia. Clinical Infectious Diseases, ciaa812,\u00a0DOI: 10.1093\/cid\/ciaa812. (23 June 2020).
    \n<\/span>    https:\/\/academic.oup.com\/cid\/article\/doi\/10.1093\/cid\/ciaa812\/5861638<\/span><\/a><\/li>\n
  3. Collins S, Potential for tocilizumab to treat moderate to severe COVID-19. HTB (14 May 2020).
    \n<\/span>    https:\/\/i-base.info\/htb\/37877<\/span><\/a><\/li>\n
  4. RECOVERY study.<\/span>
    \n    http:\/\/www.recoverytrial.net<\/a><\/li>\n
  5. Tocilizumab and remdesivir in new dual therapy study. (1 June 2020).
    \n<\/span>    https:\/\/i-base.info\/htb\/38076<\/span>\u00a0<\/span><\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Two new publications provide additional reports of positive outcomes from using the anti-IL-6 monoclonal antibody tocilizumab to treat COVID-19. The largest of these is a retrospective analysis of 544 patients hospitalised with severe COVID-19. Results were …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[283,278],"tags":[],"class_list":["post-38523","post","type-post","status-publish","format-standard","hentry","category-covid-19-investigational-drugs","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38523","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=38523"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38523\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38523"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38523"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38523"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}