Tocilizumab improves survival and other clinical outcomes in hospitalised Covid-19 patients: Study

The Lancet study revealed that Tocilizumab improves survival and other clinical outcomes in hospitalised Covid-19 patients with hypoxia and systemic inflammation. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids, according to the study.

New Delhi: Tocilizumab improves survival and other clinical outcomes in hospitalised Covid-19 patients with hypoxia and systemic inflammation, reveals a latest study compiled by renowned global medical journal The Lancet.

“These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids,” said the study.

As per the study, data were collected at study entry using a web-based case report form that included demographics and major comorbidities. All eligible and consenting patients received the usual standard of care and underwent an initial randomization.

Up to 21 days after the main randomisation and regardless of treatment allocation, recovery trial participants with clinical evidence of progressive Covid-19 (defined as oxygen saturation <92% on room air or receiving oxygen therapy, and CRP ≥75 mg/L) could be considered for randomisation to tocilizumab versus usual care alone.

Between April 23, 2020, and Jan 24, 2021, 4116 (19%) of 21 550 patients enrolled into the recovery trial at one of the 131 sites in the UK participating in the tocilizumab comparison were eligible for random assignment. 2022 patients were randomly allocated to tocilizumab and 2094 were randomly allocated to usual care.

The mean age of these participants was 63·6 years. At randomisation, 562 (14%) of 4116 patients were receiving invasive mechanical ventilation, 1686 (41%) of 4116 were receiving non-invasive respiratory support (including high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation), and 1868 (45%) of 4116 were receiving no respiratory support other than simple oxygen therapy.

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Median CRP was 143 (IQR 107–204) mg/L. 82% of patients were reported to be receiving corticosteroids at randomization.

The results of this large, randomised trial indicate that tocilizumab is an effective treatment for hospitalised Covid-19 patients who have hypoxia and evidence of inflammation. “Treatment with tocilizumab improved survival and the chances of discharge from hospital by 28 days, and reduced the chances of progressing to require invasive mechanical ventilation,” the study said.

“These benefits were consistent across all patient groups studied, including those receiving invasive mechanical ventilation, non-invasive respiratory support, or no respiratory support other than simple oxygen. The benefits of tocilizumab were clearly seen among those also receiving treatment with a systemic corticosteroid, which is now the usual standard of care for COVID-19 patients requiring treatment with oxygen,” the study further said.

Meanwhile, participating in a webinar programme on the theme “What to do after positive test result”, Dr C Ravichandra, Head of Training Division, National Tuberculosis Institute (NTI) said that Tocilizumab can be very useful in bringing back patients who are slipping away into critical stage.

“However, it should be used only in those who are on oxygen therapy and also those who don't suffer from known contraindications,” Dr Ravichandra said.

Speaking about the common treatment methods being adopted in treating severe Covid cases, Dr Ravichandra elaborated about the usage and impact of Remdesivir, Tocilizumab, Plasma therapy among others.

“Many patients will recover without Remdesivir. Also, even if used, it should be used only in specific circumstances. Remdesivir should not be used among patients who are not on oxygen support or by those who are in home settings,” Dr Ravichandra said.

Among other Covid19 medicines, the demand for Remdesivir, Fabiflu, and Tocilizumab is increasing across India.

The Union Health Ministry has recently allocated a fresh stock of 3245 doses of imported drug Tocilizumab, used for treatment of Covid-19 among the states.

Tocilizumab is an imported drug manufactured by Roche, which is being prescribed for treatment of Covid-19 patients under certain conditions in India.

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