Intensive
Care Medicine Published: 05
October 2021
Purpose
Trials of tocilizumab in patients with severe COVID-19
pneumonia have demonstrated mixed results, and the role of tocilizumab in
combination with other treatments is uncertain. Here we evaluated whether
tocilizumab plus remdesivir provides greater benefit than remdesivir alone in
patients with severe COVID-19 pneumonia.
Methods
This randomized, double-blind, placebo-controlled,
multicenter trial included patients hospitalized with severe COVID-19 pneumonia
requiring > 6 L/min supplemental oxygen. Patients were randomly
assigned (2:1 ratio) to receive tocilizumab 8 mg/kg or placebo
intravenously plus ≤ 10 days of remdesivir. The primary outcome was time
from randomization to hospital discharge or “ready for discharge” (defined as
category 1, assessed by the investigator on a 7-category ordinal scale of
clinical status) to day 28. Patients were followed for 60 days.
Results
Among 649 enrolled patients, 434 were randomly assigned to
tocilizumab plus remdesivir and 215 to placebo plus remdesivir. 566 patients
(88.2%) received corticosteroids during the trial to day 28. Median time from
randomization to hospital discharge or “ready for discharge” was 14 (95% CI
12–15) days with tocilizumab plus remdesivir and 14 (95% CI 11–16) days with
placebo plus remdesivir [log-rank P = 0.74; Cox proportional hazards ratio
0.97 (95% CI 0.78–1.19)]. Serious adverse events occurred in 128 (29.8%)
tocilizumab plus remdesivir and 72 (33.8%) placebo plus remdesivir patients; 78
(18.2%) and 42 (19.7%) patients, respectively, died by day 28.
Conclusions
Tocilizumab plus remdesivir did not shorten time to hospital
discharge or “ready for discharge” to day 28 compared with placebo plus
remdesivir in patients with severe COVID-19 pneumonia.
No comments:
Post a Comment