Survival advantage in COVID-19 seen with 8-mg/kg tocilizumab

In the treatment of hospitalized patients with COVID-19, survival outcomes appear to be more favourable with the 8-mg/kg tocilizumab regimen than with the fixed-dose tocilizumab regimen or sarilumab, according to a study.

The study included 5,485 patients with COVID-19 from 49 hospitals. They received interleukin (IL)-6 inhibitors: 8 mg/kg tocilizumab (n=2,212), fixed-dose tocilizumab (n=1,196), low-dose tocilizumab (n=843), and fixed dose sarilumab (n=1,234). Outcomes such as 60-day survival, hospital and ICU length of stay, and progression to ICU or death were evaluated and compared between treatment groups.

Patients in the 8-mg/kg and fixed-dose groups tended to be slightly younger than those in the low-dose tocilizumab and sarilumab groups. Total in-hospital mortality was 26.7 percent, with most deaths documented in the sarilumab and low-dose tocilizumab groups.

Multivariable Cox analysis showed that 60-day mortality was higher in the fixed-dose tocilizumab (hazard ratio [HR], 1.20, 95 percent confidence interval [CI], 1.04–1.39), low-dose tocilizumab (HR, 1.12, 95 percent CI, 0.97–1.31), and sarilumab (HR, 1.24, 95 percent CI, 1.08–1.42) groups than in the 8-mg/kg group. The 8-mg/kg group had lower odds for progression to ICU or death.

Meanwhile, both hospital and ICU length of stay were shorter in the low-dose tocilizumab group than in the 8-mg/kg group.

More studies are needed to validate the present findings due to potential time associated residual confounding.