Is Tocilizumab Effective in COVID-19?

SARS-CoV-2 can cause a wide range of symptoms starting from asymptomatic to mild to severe. Some cases might even require mechanical ventilation. SARS-CoV-2 can cause hypoxemic respiratory failure due to cytokine storm (severe inflammatory response). Abnormally high levels of inflammatory markers including C-reactive protein and IL-6 are seen. It was hypothesized that IL-6 blockade can stop the inflammatory cascade. Researchers at Massachusetts hospitals performed the Boston Area COVID-19 Consortium Bay tocilizumab trial.

Tocilizumab was administered early in the disease to determine whether early IL-6 receptor blockade limits COVID-19 progression to respiratory failure or death. In this randomized, double-blind, placebo-controlled trial included patients with SARS-CoV-2 infection, who showed hyperinflammatory signs. The trial included 243 patients with 42% women. Patients received a single dose of tocilizumab 8mg/kg or placebo. The primary outcome was either intubation or death and the secondary outcomes were clinical worsening and supplemental oxygen discontinuation.

Around 18% of patients in the tocilizumab group and 14.9% of the participants in the placebo group had disease worsening at 14 days. The median time to supplemental oxygen discontinuation was 4.9 days in the placebo and 5 days in the tocilizumab group. Patients had fewer serious infections complications. Around 21.2% in the placebo and 24.6% in the tocilizumab group were receiving supplemental oxygen at 14 days. The results proved that tocilizumab was not as effective in preventing intubation or death as it is being claimed.  

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Ref link: https://www.nejm.org/doi/full/10.1056/NEJMoa2028836?query=featured_coronavirus

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