Interleukin-6 receptor antagonists tocilizumab and sarilumab, both used in the treatment of rheumatoid arthritis, may improve outcomes in critically ill patients with COVID-19, according to a study.
The study, which appeared in medRxiv and is a preprint that has not yet been peer reviewed, reported outcomes of the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP). Patients with COVID-19 who were in the intensive care unit (ICU) and had started organ support within 24 hours were randomized to receive either tocilizumab (8mg/kg), sarilumab (400mg), or standard care (control). The main outcomes were in-hospital mortality and days free of organ support to day 21, which were determined by a combined ordinal scale.
When the analysis was conducted, there were 353 tocilizumab patients, 48 sarilumab group, and 402 control patients. The median number of organ support-free days was higher in both the tocilizumab (10 [interquartile range (IQR), –1 to 16]) and sarilumab groups (11 [IQR, 0-16) than the control group (0 [IQR, –1 to 15). When compared to the control group, the median adjusted odds ratio (aOR) for tocilizumab was 1.64 (95% credible intervals [CrI], 1.25-2.14) and for sarilumab, 1.76 (95% CrI, 1.17-2.91).
For patients with available data at the time of analysis, the in-hospital mortality rates were: tocilizumab, 28.0%; sarilumab, 22.2%; and control, 35.8%. The pooled mortality rate for the two treatment groups was 27.3%. When compared to the control group, the aOR for tocilizumab was 1.64 (95% CrI, 1.14-2.35) and for sarilumab, 2.01 (95% CrI, 1.18-4.71).
Adverse events (AEs) in the tocilizumab group (n=9) included secondary bacterial infection (n=1), bleeds (n=5), cardiac events (n=2), and deterioration in vision (n=1). AEs in the control group (n=11) included bleeds (n=4) and thromboses (n=7). No AEs were reported in the sarilumab group.
REMAP-CAP is an ongoing international COVID-19 trial for which findings have been previously published. In September, a study published in JAMA investigated the effect of hydrocortisone on mortality and organ support in patients with COVID-19 admitted to the ICU.
As more is learned about COVID-19 and studies are ongoing, new data and studies continue to come out, some with different results than others.
Three studies published in JAMA Internal Medicine in October evaluated the use of tocilizumab to treat COVID-19 patients with mixed results. In July a phase 3 study found that sarilumab was not effective in severely ill patients with COVID-19.