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Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia

Rosas et al., New England Journal of Medicine, doi:10.1056/NEJMoa2028700, COVACTA, NCT04320615, Apr 2021
https://c19early.org/rosas.html
Mortality -1% Improvement Relative Risk Ventilation 24% ICU admission 41% Recovery time 22% Tocilizumab  COVACTA  LATE TREATMENT  DB RCT Is late treatment with tocilizumab beneficial for COVID-19? Double-blind RCT 438 patients in multiple countries (Apr - May 2020) Lower ICU admission with tocilizumab (p=0.037) c19early.org Rosas et al., New England J. Medicine, Apr 2021 Favorstocilizumab Favorscontrol 0 0.5 1 1.5 2+
RCT 452 hospitalized patients with severe COVID-19 pneumonia showing no significant difference in clinical status or mortality at day 28 with tocilizumab. There was significantly lower ICU admission for patients not in the ICU at baseline.
risk of death, 1.5% higher, RR 1.01, p = 1.00, treatment 58 of 294 (19.7%), control 28 of 144 (19.4%).
risk of mechanical ventilation, 24.0% lower, RR 0.76, p = 0.16, treatment 51 of 183 (27.9%), control 33 of 90 (36.7%), NNT 11.
risk of ICU admission, 40.8% lower, RR 0.59, p = 0.04, treatment 27 of 127 (21.3%), control 23 of 64 (35.9%), NNT 6.8.
recovery time, 22.2% lower, relative time 0.78, p = 0.18, treatment mean 14.0 (±21.9) n=294, control mean 18.0 (±39.8) n=144, median time to improvement ≥2 categories.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Rosas et al., 22 Apr 2021, Double Blind Randomized Controlled Trial, placebo-controlled, multiple countries, peer-reviewed, median age 60.9, 23 authors, study period 3 April, 2020 - 28 May, 2020, trial NCT04320615 (history) (COVACTA).
Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia
Dr Ivan O Rosas, Norbert Bräu, Michael Waters, Ronaldo C Go, Bradley D Hunter, Sanjay Bhagani, Daniel Skiest, Mariam S Aziz, Nichola Cooper, Ivor S Douglas, Sinisa Savic, Taryn Youngstein, Lorenzo Del Sorbo, Antonio Cubillo Gracian, David J De La Zerda, Andrew Ustianowski, Min Bao, Sophie Dimonaco, Emily Graham, Balpreet Matharu, Helen Spotswood, Larry Tsai, Atul Malhotra
New England Journal of Medicine, doi:10.1056/nejmoa2028700
cohort studies. Data are needed from randomized, placebo-controlled trials.
Appendix
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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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