Add-on pembrolizumab–tocilizumab combo reduces hospitalization period in severe COVID-19

In the treatment of patients with severe COVID-19, adding the combination of pembrolizumab plus tocilizumab to standard of care (SOC) appears to result in higher and faster discharge from the hospital without sequelae, as shown in the proof-of-concept phase II COPERNICO trial.

The study randomized 12 patients (median age 68 years, 75 percent male) with severe SARS-CoV-2 infection to receive SOC alone (n=5) or in combination with pembrolizumab–tocilizumab combination (n=7). The median duration from symptoms onset to randomization was 3 days.

Pembrolizumab 200 mg was administered intravenously on days 1 and 21, then as per clinical improvement, while tocilizumab 800 mg/kg was also administered intravenously on day 1 every 12 hours and day 28 as per clinical improvement. SOC consisted of supplemental oxygen, noninvasive and invasive ventilation, antibiotic agents, vasopressor support, renal-replacement therapy, systemic steroids (eg, dexamethasone), tocilizumab, and virally targeted agents (eg, remdesivir).

Patients were followed-up through 90 days after study entry. The primary endpoint of median time to discharge was significantly shorter in the combination arm than in the SOC arm (10 vs 47.5 days; p=0.03), with zero and two COVID-19-related deaths, respectively.

With respect to the secondary outcomes, all seven patients in the combination arm had been discharged from the hospital by the end of the trial, as opposed to only three in the SOC arm (100 percent vs 60 percent; p=0.043). Furthermore, more patients in the former than the latter arm were discharged without sequelae (71.4 percent vs 20 percent; p=0.079).