India, one of the most ethnically diverse countries, conducted the first randomized trials on the use of rheumatoid arthritis medication, Tocilizumab, to reduce death risks in severe COVID-19 cases.
Headed by researchers from the University of Bristol and Medanta Institute of Education and Research, they explained that data gathered from clinical trials add to existing evidence that supports the use of Tocilizumab, an anti-inflammatory drug, in critically ill patients.
Science Behind Tocilizumab for Severe COVID-19 Cases
A study published in the journal The Lancet Respiratory Medicine entitled, "Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomized, controlled, phase 3 trial," investigated whether the anti-inflammatory drug could prevent COVID-19 progression and mortality in hospitalized patients.
The trials conducted across 12 public and private hospitals in India recruited 180 patients aged 18 years old and older that were hospitalized due to moderate to severe COVID-19. The study found administered standard care to 89 patients, while 91 patients received doses of tocilizumab and standard care.
After 28 days, researchers recorded any clinical improvement markers and assessed disease progression from moderate to severe or from severe to death. Researchers recorded patients that experience adverse side effects, serious adverse events, post-treatment infections, and whether patients required renal replacement drugs.
Critical analysis of data showed that a subset of patients suffering from a severe disease that received doses of tocilizumab might have had a reduced risk for progression to death when treated with the rheumatoid arthritis drug and standard care.
On the other hand, clinical parameters and biomarkers reliably identified patients, and optimal timing of treatment during the progression of COVID-19 are still unknown.
Efficacy and Effectivity of Tocilizumab
The authors of the study conclude that although the study does not support the routine use of the anti-inflammatory drug tocilizumab in adult COVID-19 patients, it adds to the growing evidence that the drug may help some severely ill patients.
Professor A.V. Ramanan, lead co-author of the trials from the University of Bristol says that the study suggests tocilizumab may be effective in some severe COVID-19 patients but still requires further studies. It, however, adds to existing evidence from REMAP-CAP and RECOVERY studies that demonstrate the significant impacts of tocilizumab in reducing mortality in COVID-19 patients requiring oxygen and ventilator use.
Ramanan adds that next to dexamethasone, a steroid, tocilizumab is the most significant advancement in COVID treatments that reduce deaths.
Dr. Arvinder Soin, lead co-author and chairman of the Medanta Liver Transplantation Institute, Gurugram, India explains that while there are no differences in mortality and the need for ventilation in both groups, moderate and severe categories of parties were considered. A subgroup analysis of severe COVID-19 patients in the two groups showed lower mortality at the 28-day mark.
The reported adverse events experienced by patients didn't differ between standard care arms and the anti-inflammatory drug, Tocilizumab.
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