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Drugs for COVID-19: tocilizumab


Published studies into the effects of tocilizumab in the treatment of patients with COVID-19 differ greatly in the way they have been designed and conducted. Comparisons are hampered by differences in aspects like the severity of the COVID pneumonia and the concomitant use of other anti-inflammatory and immunosuppressive drugs like corticosteroids. Two large randomised studies found a significant reduction of mortality after 28 days among patients treated with tocilizumab compared to those given a placebo. A recent Cochrane systematic review and meta-analysis confirmed this result and found a number-needed-to-treat of 31. Based on this, the preliminary advice is to give COVID patients with respiratory failure and deteriorating pneumonia a single dose of tocilizumab, in combination with dexamethasone, within 24 hours after the start of oxygen therapy with more than 6 L of oxygen a minute.

What is Ge-Bu’s opinion?
  • A systematic review and meta-analysis of eight randomised studies into tocilizumab showed a small but significant reduction of mortality on day 28 in patients with moderate or severe COVID-19 (NNT: 31).
  • For the time being, tocilizumab can be used, in combination with dexamethasone, for moderately or severely ill COVID patients within 24 hours after respiratory deterioration.
  • Questions remain about the category of patients who would benefit most from treatment with tocilizumab, the possible use of biomarkers to identify this category, the optimum timing of administration and the precise mechanism of action of this drug.

This article refers as much as possible to the current situation regarding drugs for COVID-19 and has been updated until just before publication. Studies and reports published after 5 June 2021 could not, however, be reviewed here.


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*The literature refers to the Dutch text.

Authors

  • Erik P. Schwarz
  • Lisanne L. Krens, dr, pharmacist
  • Maja Bulatović-Ćalasan