Tocilizumab May Improve Survival in Sickest Covid-19 Patients, Scientists Say

Tocilizumab, a drug normally used in rheumatoid arthritis and cancer treatments, may improve hospital survival in critically-ill COVID-19 patients admitted to the intensive care unit (ICU), according to an observational study of more than 600 people infected with the novel coronavirus.

The research, published in The Lancet Rheumatology, noted a roughly 36 per cent decrease in hospital-related mortality among the ICU patients who received tocilizumab, as compared with patients in the ICU who didn't receive it. In the study, the scientists including those from John Theurer Cancer Center in the US, assessed data on 630 patients who were admitted to the ICUs of 13 Hackensack Meridian Health hospitals from March 1 to April 22. Among other treatments, they said tocilizumab was considered for off-label usage for the patients whose respiratory symptoms were declining — many of whom were requiring mechanical ventilator support. In the observational study, the researchers noted that 210 patients received tocilizumab, and the other 420 did not.

They said COVID-19 has three phases: the early or viral phase (with fast viral replication), the pulmonary phase — marked by inflammation and pneumonia as the body tries to fight the virus in the lungs — and the inflammatory phase in which excessive inflammation reaches and affects many organs and patients are often in the ICU. As part of both the pulmonary and inflammatory phases the immune system is "supercharged" and secretes in the blood numerous molecules like cytokines and interleukin (IL)-6, which induces further inflammation, the scientists explained. They said Tocilizumab binds and blocks the interleukin (IL)-6 receptor, and helps damper the inflammatory response.

According to the researchers, higher levels of a blood test marker of inflammation, C-reactive protein, could predict which ICU patients might benefit most from the tocilizumab therapy, potentially allowing doctors to tailor therapy to those most in need. "These real-time findings have helped to point us the way forward," said Ihor Sawczuk, a co-author of the study from Hackensack Meridian Health.