Tocilizumab, originally designed for rheumatoid arthritis, has already been used to calm an overreacting immune system in patients receiving advanced immunotherapy treatment for cancer.
In a recent study from the University of Michigan, researchers found critically ill COVID-19 patients who received a single dose of this drug were 45% less likely to die overall.
In addition, these patients were more likely to be out of the hospital or off a ventilator one month after treatment.
The findings suggest a benefit from timely and targeted efforts to calm the “cytokine storm” caused by the immune system’s overreaction to the coronavirus.
The study is published in Clinical Infectious Diseases. One author is Emily Somers, Ph.D., Sc.M., an epidemiologist.
The team based their conclusions on a thorough look back at data from 154 critically ill patients during the first six weeks of the pandemic’s arrival in Michigan.
During that time, when little was known about what would help COVID-19 patients on ventilators, about half of the studied patients received tocilizumab and half did not.
Most received it within the 24-hour period surrounding their intubation.
The majority of the patients were transferred to U-M from Detroit-area hospitals after diagnosis with COVID-19, and those who received tocilizumab were less likely overall to have been transferred while already on a ventilator.
By the end of the 28-day period, after patients went on a ventilator, 18% of those who received tocilizumab had died, compared with 36% of those who had not.
When adjusted for health characteristics, this represents a 45% reduction in mortality.
Of those still in the hospital at the end of the study period, 82% of the tocilizumab patients had come off the ventilator, compared with 53% of those who didn’t receive the drug.
In all, 54% of the tocilizumab patients developed a secondary infection, mostly ventilator-associated pneumonia; 26% of those who didn’t receive tocilizumab developed such infections.
Such “superinfections” usually reduce the chance of survival for COVID-19 patients.
The ASP group developed treatment guidelines provided to Michigan Medicine physicians in mid-March that identified tocilizumab as a potentially beneficial therapy for the most severely ill COVID-19 patients.
Those guidelines also pointed out its risks and the lack of evidence for its use in COVID-19 and recommended a dose of 8 milligrams per kilogram.
This led some physicians to choose to use it, while others did not – setting the stage inadvertently for a natural comparison.
The team says further studies of tocilizumab, which is more targeted than dexamethasone in addressing the hyperinflammatory process, could include combining these agents or comparing them head-to-head.
They note that a single dose of tocilizumab is roughly 100 times more expensive than a course of dexamethasone.
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