Tocilizumab, an anti-inflammatory drug used to treat rheumatoid arthritis, improves outcomes in severely ill COVID-19 patients, finds the results of a new trial conducted in hospitals across India. Researchers from the University of Bristol and Medanta Institute of Education and Research in India who led the study, published in The Lancet Respiratory Medicine, say it adds to existing evidence supporting the drug’s use in critically ill patients. The trial called COVINTOC (the COVID India Tocilizumab phase 3 randomized controlled) was conducted in 12 public and private hospitals across India.
The trials recruited 180 adult patients who had been hospitalized with moderate to severe COVID-19. Of these, 89 patients were randomized to receive standard care, and 91 patients were randomized to receive standard care plus tocilizumab. Patients were followed up over 28 days to record any clinical improvement markers and assess disease progression from moderate to severe or from severe to death. Analysis of the data revealed a subset of patients with severe disease in whom tocilizumab might have a reduced risk for progression to death if treated with tocilizumab in addition to standard care.
However, clinical parameters or biomarkers to reliably identify these patients and the optimal timing of treatment during COVID-19 progression remain unknown. The authors conclude that while the study does not support the routine use of tocilizumab in adults with COVID-19 it adds to the growing evidence suggesting it may help some severely ill patients. A subgroup analysis of the severe patients in the two groups showed lower mortality at 28 days (8/50; 16 percent) among those who received tocilizumab compared to those who did not (14/41; 34 percent). The reported adverse events did not differ between the tocilizumab and standard care arms.
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