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Source: United Kingdom – Executive Government & Departments

A study published in the New England Journal of Medicine (NEJM) looks at tocilizumab in patients hospitalised with COVID-19 pneumonia.

Prof Athimalaipet Ramanan, Professor of Paediatric Rheumatology, University of Bristol, said:

“The role of Tocilizumab in adults with COVID-19 continues to be an area of conflicting data.  This paper shows that whilst Tocilizumab reduced the need for mechanical ventilation, it did not have an impact on survival.  It is notable that this study included more individuals of different ethnicities than some of the other studies.  However, this study excluded those who were already ventilated.

“It does appear that Tocilizumab will be of benefit in some individuals with COVID-19, the difficulty is in identifying the right subset of patients who will benefit from this intervention.  The REMAP-CAP study press release suggested that Tocilizumab might be helpful in those who are ventilated which is not the same group as studied in this trial.

“We will need more trials, particularly in different ethnic groups, to have more robust data on efficacy of Tocilizumab in COVID-19.”

Prof Anthony Gordon, Professor of Anaesthesia and Critical Care, and NIHR Research Professor, Imperial College London, said:

“This high-quality trial of tocilizumab provides important information about how best to treat the inflammation seen in severe COVID-19.  We already know from previous trials that steroids (general anti-inflammatory drugs) improve survival rates for the sickest patients.  Tocilizumab is a powerful anti-inflammatory drug that targets specific parts of the body’s inflammatory response to the coronavirus.

“The investigators demonstrated improved outcomes with tocilizumab, when measured as the need for ventilation and/or death.  However, when separated out we see the benefit appeared confined to the need for ventilation only.  This is a potentially useful effect but demonstrating benefit on other patient outcomes is also needed.  Importantly the drug appeared safe, with no sign of increased rates of new infection (always a potential concern with drugs effecting the immune system) and also it worked similarly in all patient groups, including all ethnicities.

“Combined with previous trials of tocilizumab, this encourages us that there is a role for this drug in the treatment of severe COVID-19 but we need more evidence from other ongoing larger trials to understand exactly how best to use it.”

‘Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia’ by Carlos Salama et al. will be published in the New England Journal of Medicine at 22:00 UK time on Thursday 17 December 2020.

DOI: 10.1056/NEJMoa2030340

Declared interests

Prof Athimalaipet Ramanan: “I am in the Steering committee of Trial of Tocilizumab in COVID-19 in India. Received Speaker fees/Honoraria from Roche.”

Prof Anthony Gordon: “Anthony Gordon is the UK Chief Investigator for the REMAP-CAP trial (funded by NIHR and EU FP7 grants, with contribution of drug supplies from Roche, Sanofi and SOBI).

His salary is supported through an NIHR Research Professor award and from the NIHR Imperial Biomedical Research Centre, as the Chair of Anaesthesia & Critical Care at Imperial College London and he works as a consultant in Intensive Care at Imperial College Healthcare NHS Trust.

He has received consulting fees in the past three years from GSK, Bristol Myers Squibb and 30 Technology with fees paid to his institution.

He has a current collaborative research grant from EIT Health with bioMérieux.”

MIL OSI United Kingdom