In a recent study, researchers examined the effects of the anti-inflammatory drug tocilizumab on critically ill patients with laboratory-confirmed COVID-19.
Unlike steroids, which suppress the immune system more broadly, tocilizumab specifically inhibits the receptor for the pro-inflammatory cytokine, IL-6.
They found that when tocilizumab was administered within the first two days of intensive care unit (ICU) admission, there was a 30% decrease in mortality compared to patients whose treatment did not include early use of tocilizumab.
The research was conducted by a team at Brigham and Women’s Hospital and elsewhere.
Tocilizumab has been used for several years to treat a condition known as cytokine release syndrome, which can be observed in cancer patients receiving certain types of immunotherapy.
The drug is currently approved to treat rheumatoid arthritis and giant cell arteritis, an inflammatory condition affecting large blood vessels.
It is also used to treat cancer patients who have received chimeric-antigen receptor therapy, a treatment that can stoke the body’s immune system to attack cancer cells but can also cause toxic side effects due to cytokine release syndrome (CRS), an overwhelming inflammatory response that can cause multiorgan failure.
Tocilizumab is used to treat CRS in cancer patients and is currently under investigation for use in COVID-19 patients.
In the study, the team used data from over 4,000 critically ill patients with COVID-19 admitted to ICUs at 68 sites across the US.
They examined whether tocilizumab reduces mortality in COVID-19.
Of the 3,924 patients included in the analysis, 433 received tocilizumab in the first two days of ICU admission.
The risk of death at 30-days was 27.5% and 37.1% among tocilizumab-treated and non-tocilizumab-treated patients, respectively.
Notably, patients with a more rapid disease trajectory, defined as three days or fewer from symptom onset to ICU admission, benefited from tocilizumab to a greater extent than patients with a slower disease trajectory.
This study provides crucial and robust data on tocilizumab efficacy and safety in a large population of critically ill patients with COVID-19.
On average, there was a 30% reduction in mortality for patients treated with tocilizumab in their first two days of ICU admission, there were no signs of increased risk for secondary infection, and there was only a small increase in the risk of liver function test abnormalities.
The researchers hope that these findings will help inform the design of future, well-powered clinical trials assessing the early use of tocilizumab in critically ill patients with COVID-19.
One author of the study is David E. Leaf, MD, MMSc.
The study is published in JAMA Internal Medicine.
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