Trial supports tocilizumab in moderate-to-severe COVID-19-associated pneumonia

A follow-up analysis of the CORIMUNO-TOCI-1 randomized clinical trial showed that tocilizumab may be considered for treating patients with moderate-to-severe COVID-19-associated pneumonia and high C-reactive protein levels.

Xavier Mariette, MD, PhD, the head of the rheumatology department at Hôpital Bicêtre in France, and colleagues noted that eight randomized clinical trials of tocilizumab for the treatment of COVID-19 reported heterogeneous results. Improved 28-day survival was demonstrated in only two of those trials — RECOVERY and REMAP-CAP — both of which included a significant number of patients who took dexamethasone. The studies also differed in terms of population, design and length of follow-up, the researchers said.

In CORIMUNO-TOCI-1, Mariette and colleagues compared survival rates in patients with COVID-19 who required supplemental oxygen but not high-flow or mechanical ventilation. About half the cohort received tocilizumab and the other half received usual care. The study met its primary endpoint — the proportion of patients who required noninvasive ventilation or intubation or who died at day 14 — but they found no survival difference at day 28 between patients who received tocilizumab and those who did not.

The researchers extended the follow-up period to 3 months and found that 11% of the 63 patients in the tocilizumab group and 18% of the 67 patients in the usual care group had died (adjusted HR = 0.64; 95% CI, 0.25-1.65). Those who received tocilizumab and had CRP levels higher than 15 mg/dL had an 18% chance of needing ventilation at day 14 or of dying compared with 57% in the usual care group (HR = 0.18; 95% CI, 0.06-0.59). In addition, mortality in patients with high CRP levels at day 90 was 9% in the tocilizumab group and 35% in the usual care group (HR = 0.18; 95% CI, 0.04-0.89).

Mariette and colleagues wrote that “usual care could differ among centers and over time, and few patients were taking steroids at randomization.” They also stressed that CORIMUNO-TOCI-1 trial participants are “a narrow segment of the COVID-19 population” — those with a WHO Cognitive Performance Scale score of exactly 5 and requiring at least 3 L/min of oxygen — and that the results are “not generalizable to other populations.”

“Further studies will help determine which patients with COVID-19-associated pneumonia would benefit the most from a combination of tocilizumab and dexamethasone,” they wrote.