Researchers report lower risk of dying among critically-ill COVID-19 patients after drug
Researchers from the University of Michigan (U-M), US, have noticed that critically-ill COVID-19 patients who received an intravenous drugwere 45% less likely to die and would more likely be out of the hospital or off a ventilator in about one month after treatment.While there was a lower risk of death in patients who received intravenous tocilizumab – originally designed for rheumatoid arthritis–they were also twice as likely to develop an additional infection, on top of the novel coronavirus.
The researchers looked at data from 154 patients treated at Michigan Medicine, U-M’s academic medical centre. During that time, about half of the studied patients received tocilizumab and half did not. Most received it within the 24-hour period surrounding their intubation.
By the end of the 28-day period after patients went on a ventilator, 18% of those who received tocilizumab had died, compared with 36% of those who had not. When adjusted for health characteristics, this represents a 45% reduction in mortality. Of those still in the hospital at the end of the study period, 82% of the tocilizumab patients had come off the ventilator, compared with 53% of those who didn’t receive the drug.
In all, 54% of the tocilizumab patients developed a secondary infection, mostly ventilator associated pneumonia while 26% of those who didn’t receive tocilizumab developed such infections. Such “superinfections” usually reduce the chance of survival for COVID-19 patients.
Emily Somers, an epidemiologist who has studied both rheumatologic and immunologic diseases, said the team was uncertain to find a benefit, a risk, or no clear effect associated with tocilizumab in the patients with life-threatening COVID-19. “But the difference in mortality despite the increase in secondary infection is quite pronounced, even after accounting for many other factors,” she admitted.
Meanwhile, Jason Pogue, a clinical professor at the U-M College of Pharmacy and an infectious disease pharmacist at Michigan Medicine, recommends the steroid dexamethasone as the first choice to treat critically ill COVID-19 patients.
“[…] we recommend reserving tocilizumab for the treatment of select patients who decompensate while on or after receiving dexamethasone or in patients where the risks of adverse events from steroid therapy outweigh the potential benefits,” Pogue said, citing a UK study.
Pogue also notes that a single dose of tocilizumab is roughly 100 times more expensive than a course of dexamethasone. “Further studies could include combining these agents or comparing them head-to-head.”
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