Tocilizumab Ameliorates the Hypoxia in COVID-19 Moderate Patients with Bilateral Pulmonary Lesions: A Randomized, Controlled, Open-Label, Multicenter Trial

Wang et al., SSRN Electronic Journal, doi:10.2139/ssrn.3667681, ChiCTR2000029765, Dec 2020
Progression 27% improvement lower risk ← → higher risk Recovery 54% Recovery, hypoxia rec.. 79% Hospitalization time -8% Time to viral- -6% Tocilizumab  Wang et al.  LATE TREATMENT RCT Is late treatment with tocilizumab beneficial for COVID-19? RCT 65 patients in China (February - March 2020) Lower progression (p=0.53) and improved recovery (p=0.41), not sig. c19early.org Wang et al., SSRN Electronic J., December 2020 0 0.5 1 1.5 2+ RR
RCT 65 COVID-19 patients in China showing improvement in hypoxia recovery with tocilizumab treatment, especially in moderate patients with bilateral pulmonary lesions.
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter et al. show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
Standard of Care (SOC) for COVID-19 in the study country, China, is average with moderate efficacy for approved treatments2.
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risk of progression, 27.1% lower, RR 0.73, p = 0.53, treatment 7 of 24 (29.2%), control 8 of 20 (40.0%), NNT 9.2.
risk of no recovery, 54.4% lower, RR 0.46, p = 0.41, treatment 2 of 34 (5.9%), control 4 of 31 (12.9%), NNT 14.
risk of no recovery, 79.2% lower, RR 0.21, p = 0.03, treatment 2 of 24 (8.3%), control 8 of 20 (40.0%), NNT 3.2, hypoxia recovery.
hospitalization time, 8.3% higher, relative time 1.08, p = 0.35, treatment median 26.0 IQR 10.0 n=34, control median 24.0 IQR 13.0 n=31.
time to viral-, 6.2% higher, relative time 1.06, p = 0.54, treatment median 17.0 IQR 8.0 n=34, control median 16.0 IQR 9.5 n=31.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wang et al., 31 Dec 2020, Randomized Controlled Trial, China, peer-reviewed, 26 authors, study period 13 February, 2020 - 13 March, 2020, trial ChiCTR2000029765. Contact: xxlahh8@ustc.edu.cn, hfmxd@sina.com, ustcwhm@ustc.edu.cn.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 China United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Pakistan Argentina Vietnam Peru Philippines Spain Brazil Italy France Japan 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 Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR China favored low-cost treatments.The average efficacy of treatments was moderate.Low-cost treatments improve early treatment, andprovide 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 China United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Pakistan Argentina Vietnam Peru Philippines Spain Brazil Italy France Japan 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 Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria China favored low-cost treatments.The average efficacy was moderate.Low-cost protocols improve early treatment,and add complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Tocilizumab ameliorates the hypoxia in COVID-19 moderate patients with bilateral pulmonary lesions: a randomized, controlled, open-label, multicenter trial
Dongsheng Wang, Binqing Fu, Zhen Peng, Dongliang Yang, Mingfeng Han, Min Li, MS Yun Yang, MD, A Pan MD Tianjun Yang, Liangye Sun, Wei Li, Wei Shi, Xin Yao, Yan Ma, BS Fei Xu, MS Xiaojing J Wang, Jun Chen, MS Daqing Xia, Yubei Sun, Lin Dong, Jumei Wang, Xiaoyu Zhu, Min Zhang, PhD Yonggang Zhou, Aijun Pan, MD Xiaowen Hu, MD Xiaodong Mei, Dr Haiming Wei, MD Xiaoling Xu, Wang Ms, Chen Bs, Wei Phd
65 Patients were assessed for eligibility 33 patients randomly assigned to the tocilizumab group 32 patients randomly assigned to the control group 34 patients Intention to treat population 31 patients Intention to treat population 1 patient transferred to the tocilizumab group 34 patients included in safety population 31 patients included in safety population Figure 1.
References
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Late treatment
is less effective
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