Late onset infectious complications and safety of tocilizumab in the management of COVID‐19
et al., Journal of Medical Virology, doi:10.1002/jmv.26429, Aug 2020
Retrospective 74 hospitalized COVID-19 patients treated with tocilizumab and 74 matched controls, showing higher mortality with tocilizumab.
Standard of Care (SOC) for COVID-19 in the study country,
the USA, is very poor with very low average efficacy for approved treatments1.
Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
This may explain in part the very high mortality seen in this study.
Results may differ in countries with improved SOC.
|
risk of death, 70.6% higher, RR 1.71, p = 0.05, treatment 29 of 74 (39.2%), control 17 of 74 (23.0%).
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Pettit et al., 21 Aug 2020, retrospective, USA, peer-reviewed, 7 authors, study period 1 March, 2020 - 25 April, 2020.
DOI record:
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"abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Tocilizumab (TCZ) has been used in the management of COVID‐19‐related cytokine release syndrome (CRS). Concerns exist regarding the risk of infections and drug‐related toxicities. We sought to evaluate the incidence of these TCZ complications among COVID‐19 patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All adult inpatients with COVID‐19 between 1 March and 25 April 2020 that received TCZ were included. We compared the rate of late‐onset infections (>48 hours following admission) to a control group matched according to intensive care unit admission and mechanical ventilation requirement. Post‐TCZ toxicities evaluated included: elevated liver function tests (LFTs), GI perforation, diverticulitis, neutropenia, hypertension, allergic reactions, and infusion‐related reactions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventy‐four patients were included in each group. Seventeen infections in the TCZ group (23%) and 6 (8%) infections in the control group occurred >48 hours after admission (<jats:italic>P</jats:italic> = .013). Most infections were bacterial with pneumonia being the most common manifestation. Among patients receiving TCZ, LFT elevations were observed in 51%, neutropenia in 1.4%, and hypertension in 8%. The mortality rate among those that received TCZ was greater than the control (39% versus 23%, <jats:italic>P</jats:italic> = .03).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Late onset infections were significantly more common among those receiving TCZ. Combining infections and TCZ‐related toxicities, 61% of patients had a possible post‐TCZ complication. While awaiting clinical trial results to establish the efficacy of TCZ for COVID‐19 related CRS, the potential for infections and TCZ related toxicities should be carefully weighed when considering use.</jats:p></jats:sec>",
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Late treatment
is less effective
is less effective
