{"id":38827,"date":"2020-08-28T07:21:19","date_gmt":"2020-08-28T07:21:19","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=38827"},"modified":"2020-09-09T14:59:45","modified_gmt":"2020-09-09T14:59:45","slug":"tocilizumab-associated-with-better-outcomes-from-covid-19-in-us-study","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38827","title":{"rendered":"Tocilizumab associated with better outcomes from COVID-19 in US study"},"content":{"rendered":"
\n

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

\n

Another large observational cohort has reported positive results from using the anti-IL-6 monoclonal antibody tocilizumab to treat COVID 19. [1]<\/strong><\/p>\n<\/div>\n

\n

The rationale for benefit is related to high levels of IL-6 associated with the cytokine storm in late and more serious COVID-19. This study adds to growing evidence suggesting benefit including those previously reported in this bulletin. [2, 3]<\/p>\n<\/div>\n

\n

The current study, published on 14 August 2020 in Lancet Rheumatology, was a retrospective cohort analysis from 13 hospitals in New Jersey, US.<\/p>\n<\/div>\n

\n

Between 1 March and 22 April 2020 a total of <\/span>764 adults with COVID-19 hospitalised in the intensive care units and 210 (27%) of these used tocilizumab.<\/p>\n<\/div>\n

\n

Significant baseline differences in people using tocilizumab included being younger: median age 62 years (IQR: 53 to 71) vs\u00a068 years (IQR: 58 to 78); p=0.0003; more likely to be male (74% vs 63%, p=0.0037); and less likely to be in nursing home (5% vs 14%, p=0.0004). There were no significant differences in terms of comorbidities but a higher likelihood of using hydroxychloroquine or azithromycin.<\/span><\/p>\n<\/div>\n

\n

A propensity score-matched population included 630 adults, 210 who received at least one infusion of tocilizumab and 420 who did not receive tocilizumab.\u00a0Nearly everyone (206\/210, 98%) received 400 mg flat dosing, two received 8 mg\/kg, and two received other doses; 185 (88%) received one infusion and 25 (12%) received a second infusion.\u00a0<\/span><\/p>\n<\/div>\n

\n

Mortality was 57% (358\/639) overall but in adjusted analysis was significantly lower in the tocilizumab group 102 (49%) vs\u00a0256 (61%): HR 0.64 (95% CI: 0.47 to 0.87); p=0\u00b70040.<\/span><\/p>\n<\/div>\n

\n

Median survival from time of admission was not reached for tocilizumab (95% CI 23 days to not reached) vs 19 days (16 to 26), with a hazard ratio 0.71 (95% CI: 0\u00b756 to 0\u00b789) p=0\u00b70027.<\/span><\/p>\n<\/div>\n

\n

These associations were similar in subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg\/dL or higher.<\/span><\/p>\n<\/div>\n

\n

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

These results add to the growing number of studies that have reported potentially positive results with tocilizumab.\u00a0Four earlier studies were reviewed in a recent earlier issue of HIV and COVID-19. [3]<\/span><\/strong><\/p>\n<\/div>\n

\n

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

\n

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

Although the risk of serious infections related to tocilizumab is not considered greater than placebo, two cases were reported as we went to press of acute HSV-1-mediated liver failure, both fatal, in two Italian COVID-19 patients treated with tocilizumab.\u00a0[6]<\/strong><\/p>\n

However, the large randomised placebo-controled COVACTA study failed to show any benefit from tocilizumab. [7]<\/strong><\/p>\n<\/div>\n

\n

References<\/p>\n<\/div>\n

\n
    \n
  1. Biran N et al. Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study. The Lancet Rheumatology. DOI: 10.1016\/S2665-9913(20)30277-0. (14 August 2020).
    \n<\/span>https:\/\/www.thelancet.com\/journals\/lanrhe\/article\/PIIS2665-9913(20)30277-0\/fulltext<\/a><\/li>\n
  2. Collins S. Further positive reports from tocilizumab to treat COVID-19. HTB (22 July 2020).
    \n    https:\/\/i-base.info\/htb\/38523<\/a><\/li>\n
  3. Collins S. Potential for tocilizumab to treat moderate to severe COVID-19. HTB (14 May 2020).
    \n    https:\/\/i-base.info\/htb\/37877<\/a><\/li>\n
  4. RECOVERY study
    \n    http:\/\/www.recoverytrial.net<\/a><\/li>\n
  5. Tocilizumab and remdesivir in new dual therapy study. (1 June 2020).
    \n    https:\/\/i-base.info\/htb\/38076\u00a0<\/a><\/li>\n
  6. Busani S et al. Two fatal cases of acute liver failure due to HSV-1 infection in COVID-19 patients following immunomodulatory therapies. CID ciaa1246. DOI: 10.1093\/cid\/ciaa1246. (25 August 2020).
    \n    https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciaa1246\/5896943<\/a><\/li>\n
  7. Collins S. Tocilizumab fails to meet clinical endpoints in randomised COVACTA study: other studies continue. HTB (9 September 2020).
    \n    https:\/\/i-base.info\/htb\/38965<\/a><\/li>\n<\/ol>\n

    This article was originally posted on 21 August 2020 and updated on 9 September 2020..<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Another large observational cohort has reported positive results from using the anti-IL-6 monoclonal antibody tocilizumab to treat COVID 19. [1] The rationale for benefit is related to high levels of IL-6 associated with the cytokine storm …<\/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-38827","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\/38827","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=38827"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38827\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}