Tocilizumab cuts COVID-19 mortality when administered during the early inflammatory stage

Tocilizumab does not seem to prevent the progression of the coronavirus disease 2019 (COVID-19) to critical disease but may still be valuable in severely ill patients when used during the early inflammatory stages, a recent study has found.

Researchers conducted a retrospective analysis of 140 patients with moderate to critical COVID-19, of whom 79 were given tocilizumab in different standard doses (< 400 mg, 400–800 mg, >800 mg). The drug was administered at the viral (1–7 days after symptom onset), early inflammatory (8–15 days), or late inflammatory (≥16 days) stages. Outcomes included mortality, respiratory support requirements, and markers of inflammation.

Compared to COVID-19 patients who received standard treatment (enoxaparin plus 6-mg dexamethasone once a day), those who received any additional dose of tocilizumab saw no significant improvement in mortality.

However, when the tocilizumab group was further divided according to disease severity and the timing of drug administration, the researchers saw significant survival benefit among severely ill patients who received the drug during the early inflammatory stage (vs standard treatment: 4.1 percent vs 25.7 percent; p=0.03). A similar reduction in death risk was reported for those who received the 400–800-mg dose of tocilizumab (3.7 percent vs 25.7 percent; p=0.01).

“These observations suggest that COVID-19 may have a wide clinical spectrum that is not well understood, and that the efficacy of tocilizumab may vary according to the different clinical presentations, and especially, to the different COVID-19 stages. More research is needed to fully understand such phenomenon in order to adequate the pharmacotherapy to the different clinical presentations,” the researchers said.