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
Late treatmentRCT · 438 patients · multinational · Apr – May 2020
Tocilizumab for COVID-19
Outcome
Improvement
Relative Risk · 95% CI
Lower ICU admission with tocilizumab
p = 0.037
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.
OutcomeImprovementEffect · pTreatmentControl
risk of death 1.5% higher · RR 1.01 · p = 1.00 1.5% higherRR 1.01p = 1.00 58 of 294 (19.7%) 28 of 144 (19.4%) 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 24.0% lowerRR 0.76p = 0.16 51 of 183 (27.9%) 33 of 90 (36.7%) 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* 40.8% lowerRR 0.59p = 0.04* 27 of 127 (21.3%) 23 of 64 (35.9%) 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 22.2% lowerrelative time 0.78p = 0.18 14.0 [12.0-17.0] n=294 18.0 [15.0-28.0] n=144 treatment 14.0 [12.0-17.0] n=294, control 18.0 [15.0-28.0] n=144median time to improvement ≥2 categories

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates. * p < 0.05

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