BACKGROUND AND PURPOSE:

• Tocilizumab is a monoclonal antibody that can reduce inflammation and may be beneficial for treating severe COVID-19
• The RECOVERY Collaborative Group (The Lancet, 2021) evaluated the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation

METHODS:

• Randomized, controlled, open-label, platform trial
  • Randomized Evaluation of COVID-19 Therapy (RECOVERY), which assesses several possible COVID-19 treatments
• Setting
  • UK
  • Between April 23, 2020 and Jan 24, 2021
• Participants
  • Patients hospitalized with COVID-19
  • Hypoxia: oxygen saturation <92% on air or requiring oxygen therapy and
  • Evidence of systemic inflammation: C-reactive protein ≥75 mg/L
• Interventions (1:1 randomization)
  • Standard care alone
  • Standard care plus intravenous tocilizumab at a dose of 400 mg to 800 mg (depending on weight)
    • A second dose could be given 12 to 24 h later if the patient’s condition had not improved
• Primary outcome
  • 28-day mortality, assessed in the intention-to-treat population

RESULTS:

• Tocilizumab: 2022 patients | Usual care: 2094 patient
  • Also received systemic corticosteroids: 82%
• 28-day mortality was lower in the tocilizumab group
  • Tocilizumab: 31%
  • Usual care: 35%
  • Rate ratio 0.85 (95% CI, 0.76 to 0.94; p = 0.0028)
• Subgroup analysis
  • Results consistent across all analyses, including those receiving systemic corticosteroids
• Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days
  • Tocilizumab: 57%
  • Usual care: 50%
  • Rate ratio 1.22 (95% CI, 1.12 to 1.33; p < 0.0001)
• Not receiving invasive mechanical ventilation at baseline
  • Patients in tocilizumab group were less likely to reach a composite endpoint of invasive mechanical ventilation or death
  • Tocilizumab: 35%
  • Usual care: 42%
  • Risk ratio 0.84 (95% CI, 0.77 to 0.92; p < 0.0001)

CONCLUSION:

• For patients hospitalized with hypoxia and systemic inflammation associated with COVID-19, tocilizumab reduced 28-day mortality, and increased the likelihood of discharge from the hospital by 28-days
• Benefit was seen whether the patient was on mechanical ventilation or systemic corticosteroids
• The authors state

The RECOVERY trial has shown that for patients hospitalised with severe COVID-19, treatment with tocilizumab reduces mortality, increases the chances of successful hospital discharge, and reduces the chances of requiring invasive mechanical ventilation

These findings require an update to clinical guidelines, which has already begun, and efforts to increase the global availability and affordability of tocilizumab

Learn More – Primary Sources:

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

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