Tocilizumab combined with favipiravir in the treatment of COVID-19: A multicenter trial in a small sample size
Biomedicine & Pharmacotherapy, doi:10.1016/j.biopha.2020.110825
Background: Since December 2019, COVID-19 has spread to almost every corner of the world. In theory, tocilizumab and favipiravir are considered to be reliable drugs for the treatment of COVID-19 with elevated IL-6. We aimed to assess the efficacy and safety of tocilizumab combined with favipiravir in patients with COVID-19. Methods: This was a multicenter trial in adults with COVID-19. Patients were randomly assigned (3:1:1) to a 14day combination of favipiravir combined with tocilizumab (combination group), favipiravir, and tocilizumab. The primary outcome was the cumulative lung lesion remission rate (lung CT examination indicated absorption of lung inflammation). Results: Between Feb 2 and March 15, 2020, 26 patients were recruited; 14 were randomly assigned to the combination group, 7 were assigned to the favipiravir group and 5 were assigned to the tocilizumab group. The cumulative lung lesion remission rate at day 14 was significantly higher in combination group as compared with favipiravir group (P = 0.019, HR 2.66 95 % CI [1.08-6.53]). And there was also a significant difference between tocilizumab and favipivavir (P = 0.034, HR 3.16, 95 % CI 0.62-16.10). In addition, there was no significant difference between the combination group and the tocilizumab group (P = 0.575, HR 1.28 95 %CI 0.39-4.23). Furthermore, combined therapy can also significantly relieve clinical symptoms and help blood routine to return to normal. No serious adverse events were reported. Conclusion: Tocilizumab combined with or without favipiravir can effectively improve the pulmonary inflammation of COVID-19 patients and inhibit the deterioration of the disease.
Ethical approval and consent to participate This study has been approved by the Ethics Committee of Peking University First Hospital (2020-032) and has been registered in Chinese clinical trial registry (ChiCTR2000030096 and NCT04310228). All patients signed the informed consent form.
Consent for publication
Authors' contributions Hong Zhao, Qi Zhu and Chi Zhang drafted the manuscript; Ming Wei, Yuhong Qin, Guilin Chen, Ke Wang, and Junhua Yu participated in the collection and arrangement of clinical cases; Chi Zhang and Jiawen Li participated in the creation of figures and tables; Zhao Wu, and Chi Zhang participated in the proofreading of this paper; Xianxiang Chen and Guiqiang Wang provided the overall principle and direction of the study. All authors read and approved the final manuscript.
Declaration of Competing Interest The authors report no declarations of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.biopha.2020.110825.
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