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Tocilizumab in COVID‐19 pneumonia: Practical proposals based on a narrative review of randomised trials
Author(s) -
Klopfenstein Timothée,
Gendrin Vincent,
KadianeOussou N'dri Juliette,
Conrozier Thierry,
Zayet Souheil
Publication year - 2022
Publication title -
reviews in medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.06
H-Index - 90
eISSN - 1099-1654
pISSN - 1052-9276
DOI - 10.1002/rmv.2239
Subject(s) - tocilizumab , medicine , mechanical ventilation , pneumonia , clinical endpoint , randomized controlled trial , intensive care medicine , disease
In this article, we express our opinion about tocilizumab as an effective treatment in coronavirus disease 2019, based on a narrative review and a deep analysis of tocilizumab randomised trial results. Eight trials were included. No one was in favour for controlled arm about main endpoint of death or mechanical ventilation incidence at day 28–30. Five trials on heterogenous populations seem to not demonstrate tocilizumab efficacy, but showed encouraging results in subgroup analysis on severe/critical patients (in favour for tocilizumab). Trials on severe/critical COVID‐19 pneumonia as REMAP‐CAP and RECOVERY showed mortality benefit of tocilizumab administration; CORIMUNO, REMAP‐CAP and RECOVERY showed that tocilizumab decreased the incidence of mechanical ventilation. No safety signal about tocilizumab used was noticed in all trials. We concluded that tocilizumab reduces mortality and mechanical ventilation requirement if administered with the right timing in COVID‐19 pneumonia. The challenge now is to define the optimal group and timing for tocilizumab benefit and we suggest that: (i) tocilizumab has a place in treatment of severe/critical COVID‐19 pneumonia, with a high level of O 2 flow or noninvasive ventilation or high flow nasal cannula; (ii) possibly early after intubation in patients on mechanical ventilation. Initiating tocilizumab in critically ill patients early before irreversible respiratory failure, especially in patients at an inflammatory stage could be the key to successful outcome.