Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia

Hermine et al., JAMA Internal Medicine, doi:10.1001/jamainternmed.2020.6820, CORIMUNO-TOCI-1, NCT04331808, Jan 2021
Mortality, day 28 7% improvement lower risk ← → higher risk Mortality, day 14 -24% Ventilation 62% Progression 34% Tocilizumab  CORIMUNO-TOCI-1  LATE TREATMENT RCT Is late treatment with tocilizumab beneficial for COVID-19? RCT 130 patients in France (March - April 2020) Lower ventilation with tocilizumab (p=0.047) c19early.org Hermine et al., JAMA Internal Medicine, Jan 2021 0 0.5 1 1.5 2+ RR
RCT 130 hospitalized COVID-19 patients with moderate or severe pneumonia showing tocilizumab did not reduce WHO-CPS scores below 5 at day 4 (primary outcome), but reduced the proportion of patients needing noninvasive ventilation, high-flow oxygen, mechanical ventilation, or death by day 14. There was no significant difference in 28-day mortality.
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risk of death, 6.9% lower, RR 0.93, p = 1.00, treatment 7 of 63 (11.1%), control 8 of 67 (11.9%), NNT 121, day 28.
risk of death, 24.1% higher, RR 1.24, p = 0.77, treatment 7 of 63 (11.1%), control 6 of 67 (9.0%), day 14.
risk of mechanical ventilation, 62.0% lower, RR 0.38, p = 0.047, treatment 5 of 63 (7.9%), control 14 of 67 (20.9%), NNT 7.7, day 14.
risk of progression, 33.5% lower, RR 0.66, p = 0.18, treatment 15 of 63 (23.8%), control 24 of 67 (35.8%), NNT 8.3, noninvasive ventilation, mechanical ventilation, or death, day 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Hermine et al., 1 Jan 2021, Randomized Controlled Trial, France, peer-reviewed, median age 64.0, 594 authors, study period 31 March, 2020 - 18 April, 2020, trial NCT04331808 (history) (CORIMUNO-TOCI-1). Contact: ohermine@gmail.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 France United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR France favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 France United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria France favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia
MD Olivier Hermine, PhD; Xavier Mariette, PhD; Pierre-Louis Tharaux, MD, PhD Matthieu Resche-Rigon, PhD Raphaël Porcher, PhD Philippe Ravaud, Serge Bureau, Maxime Dougados, Annick Tibi, Elie Azoulay, Jacques Cadranel, Joseph Emmerich, Muriel Fartoukh, Bertrand Guidet, Marc Humbert, Karine Lacombe, Matthieu Mahevas, Frédéric Pene, Valérie Pourchet-Martinez, Frédéric Schlemmer, Yazdan Yazdanpanah, Gabriel Baron, Elodie Perrodeau, Damien Vanhoye, Cécile Kedzia, Lauren Demerville, Anne Gysembergh-Houal, Alexandre Bourgoin, Sarah Dalibey, MD, PhD Matthieu Resche-Rigon, Nabil Raked, Lakhdar Mameri, Stéphanie Alary, Samir Hamiria, Thinhinane Bariz, Hala Semri, Dhiaa Meriem Hai, Moustafa Benafla, Mohamed Belloul, Pernelle Vauboin, Saskia Flamand, Claire Pacheco, Anouk Walter-Petrich, Emilia Stan, Souad Benarab, Corine Nyanou, Claire Montlahuc, Lucie Biard, Robin Charreteur, Celine Dupré, Kévin Cardet, Blandine Lehmann, Kamyl Baghli, Claire Madeleine, Eric D'ortenzio, Oriane Puéchal, Caroline Semaille, Laurent Savale, Anatole Harrois, Samy Figueiredo, Jacques Duranteau, Nadia Anguel, Xavier Monnet, Christian Richard, Jean-Louis Teboul, Philippe Durand, Pierre Tissieres, Mitja Jevnikar, David Montani, Stéphan Pavy, Nicolas Noel, Olivier Lambotte, Lelia Escaut, Stéphane Jauréguiberry, Elodie Baudry, Christiane Verny, Edouard Lefèvre, Mohamad Zaidan, Clotilde Le Tiec Le Tiec, Céline Verstuyft Verstuyft, Anne-Marie Roques, Lamiae Grimaldi, Domitille Molinari, Gaël Leprun, Alain Fourreau, Laurent Cylly, Myriam Virlouvet, Ramdane Meftali, Solène Fabre, Marion Licois, Asmaa Mamoune, Yacine Boudali, Sophie Georgin-Lavialle, Patricia Senet, Angèle Soria, Antoine Parrot, Hélène François, Nathalie Rozensztajn, Emmanuelle Blin, Pascaline Choinier, Juliette Camuset, Jean-Simon Rech, Antony Canellas, Camille Rolland-Debord, Nadège Lemarié, Nicolas Belaube, Marine Nadal, Martin Siguier, Camille Petit-Hoang, Julie Chas, Elodie Drouet, Matthieu Lemoine, Audrey Phibel, Lucie Aunay, Eliane Bertrand, Sylviane Ravato, Marie Vayssettes, Anne Adda, Celine Wilpotte, Pélagie Thibaut, Julie Fillon, Isabelle Debrix, Soraya Fellahi, Jean-Philippe Bastard, Guillaume Lefèvre, Vincent Fallet, Jacques-Eric Gottenberg, Yves Hansmann, Emmanuel Andres, Sophie Bayer, Guillaume Becker, Frédéric Blanc, Stéphane Brin, Vincent Castelain, Emmanuel Chatelus, Eva Chatron, Olivier Collange, François Danion, Frédéric De Blay, Eric Demonsant, Pierre Diemunsch, Sophie Diemunsch, Renaud Felten, Bernard Goichot, Valentin Greigert, Aurélien Guffroy, Bob Heger, Anne Hutt, Charlotte Kaeuffer, Loic Kassegne, Anne Sophie Korganow, Pierrick Le Borgne, Nicolas Lefebvre, Tristan Martin, Paul Michel Mertes, Catherine Metzger, Nicolas Meyer, Gabriel Nisand, Eric Noll, Mathieu Oberlin, Sophie Ohlmann-Caillard, Vincent Poindron, Julien Pottecher, Yvon Ruch, Cédric Sublon, Hakim Tayebi, François Weill, Arsène Mekinian, Dorothée Chopin, Olivier Fain, Marc Garnier, Jessica Krause Le Garrec, Marjolaine Morgand, Jerome Pacanowski, Tomas Urbina, Chloe Mcavoy, Maria Pereira, Gladys Aratus, Laurence Berard, Tabassome Simon, Anne Daguenel Nguyen, Marie Antignac, Céline Leplay, Jean-Benoit Arlet, Jean-Luc Diehl, Florence Bellenfant, Anne Blanchard, Alexandre Buffet, Bernard Cholley, Antoine Fayol, Edouard Flamarion, Anne Godier, Thomas Gorget, Sophie-Rym Hamada, Caroline Hauw-Berlemont, Jean- Sébastien Hulot, David Lebeaux, Marine Livrozet, Adrien Michon, Arthur Neuschwander, Marie-Aude Penet, Benjamin Planquette, Brigitte Ranque, Olivier Sanchez, Geoffroy Volle, Sandrine Briois, Mathias Cornic, Virginie Elisee, Denis, Jesuthasan, Juliette Djadi-Prat, Pauline Jouany, Ramon Junquera, Mickael Henriques, Amina Kebir, Isabelle Lehir, Jeanne Meunier, Florence Patin, Valérie Paquet, Anne Tréhan, Véronique Vigna, Brigitte Sabatier, Damien Bergerot, Charlène Jouve, Camille Knosp, Olivia Lenoir, Nassim Mahtal, Léa Resmini, Xavier Lescure, Jade Ghosn, Antoine Bachelard, Timothee Bironne, Raphael Borie, Agathe Bounhiol, Catherine Boussard, Jeanne Chauffier, Solaya Chalal, Lynda Chalal, Malikhone Chansombat, Paul Crespin, Bruno Crestani, Olivia Daconceicao, Laurene Deconinck, Hilippe Dieude, Antoine Dossier, Marie Dubert, Greggory Ducrocq, Axelle Fuentes, Anne Gervais, Marie Gilbert, Valentina Isernia
JAMA Internal Medicine, doi:10.1001/jamainternmed.2020.6820
IMPORTANCE Severe pneumonia with hyperinflammation and elevated interleukin
Author Contributions: Drs Resche-Rigon and Porcher had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors contributed equally to this study. Role of the Funder/Sponsor: The funding agencies had no access to the trial data and had no role in the design, conduct or reporting of the trial. Roche donated TCZ in unrestricted grant, and had no role in the trial design or conduct; the collection, management, analysis, interpretation of the data; or in the preparation, review of the manuscript or the approval of the manuscript for submission. Additional Information: A coordination committee was responsible for the design, conduct, and reporting of the trial, and an independent data and safety monitoring board (DSMB) oversees all CORIMUNO trials (Supplement 4).
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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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