Tocilizumab

Tocilizumab slightly reduces the number of serious unwanted effects in COVID-19 patients

Gujarat government says it doesn't have power to direct private firm to fix Tocilizumab injection price | Deccan Herald

 

Why is Systemic Tocilizumab for the treatment of COVID-19 important?

An immune response is how the body recognises and defends itself against harmful substances, such as viruses. COVID-19 is an infectious disease affecting the lungs and airways, disrupting the immune system, causing it to over-react and produce dangerously high levels of inflammation. Interleukin-6 (IL-6) is a protein involved in triggering inflammation. Blocking the production of interleukin-6 could reduce inflammation and help the immune system fight COVID-19.

 

Does Tocilizumab work for the treatment of COVID-19?   

  • Tocilizumab (one of the medications that blocks interleukin-6) reduced the number of people who died of any cause after 28 days.
  • Moderate‐certainty evidence suggests that Tocilizumab probably slightly reduces the number of serious unwanted effects, such as life-threatening conditions or death. The results were inconclusive surrounding severity of COVID-19; that is, how many patients died of COVID-19, needed a ventilator or additional organ support at 28 days.

Equity: Does Systemic corticosteroids work in the disadvantaged?

  • The most severe effects of COVID-19 disproportionally affects older people. Interleukin-6 blocking agents such as Tocilizumab have proven to be effective in this population group—the mean age of this study comprised of people aged between 55 and 65 years old.

Intervention Delivery

  • The following IL-6 blocking agents were used with no restriction of dose, frequency, or mode of administration: Tocilizumab, Sarilumab, Clazakizumab, Olokizumab, Siltuximab,  and Levilimab
  • The comparator in this review was standard care alone or with placebo

Population and Setting

  • The trials evaluated children or adults with suspected, probable, or confirmed ambulatory or hospitalised COVID-19 
  • A total of 6896 participants (10 RCTs) were included in the analysis of this review
  • The studies were conducted in Brazil, China, France, Italy, UK, and USA
  • The mean age range varied from 56 to 65 years; 4572/6896 (66.3%) were men

Summary of Findings [SOF] Table: Tocilizumab compared to standard care/placebo for/mild/moderate/severe/critical COVID-19 

 

Patient or population: Participants with mild/moderate/severe/critical COVID-19

Settings: Brazil, China, France, Italy, UK, USA

Intervention: Tocilizumab
Comparison: Standard care/Placebo

 

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

   Certainty of the evidence
(GRADE)

 

Risk with standard care/placebo

Risk with Tocilizumab

 

 

 

Clinical improvement D28

515 per 1000

 

545 per 1000

(515 to 581)

RR 1.06 (1.00 to 1.13)

5585 (7 RCTS)

Moderate

All cause mortality D28

291 per 1000

 

259 per 1000

(239 to 283)

 

RR 0.89

(0.82 to 0.97)

6363 (8 RCT)

High

 

RR=risk ratio

CI=confidence interval

HR= hazard ratio

 

About quality of evidence (GRADE)
High quality (High): Further research is very unlikely to change our confidence in the estimate of effect. 
Moderate quality (Moderate): Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality (Low): Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality (Very low): We are very uncertain about the estimate.

 

 

 

 

Relevance of the review for disadvantaged communities

Findings

Interpretation

Equity - Which of the PROGRESS groups examined

 

Participants in the study were people with mild/moderate/severe/critical COVID-19. The mean age of the participants range varied from 56 to 65 years; 4572/6896 (66.3%) were men.

 

On average, Tocilizumab reduces all-cause mortality at day 28 (D28) and probably results in slightly fewer serious adverse events compared to standard care alone or placebo. It is likely that Tocilizumab increases time to clinical improvement and decreases time to intubation or death.

Equity Applicability

The participants in the included studies were from middle-income and higher income countries (Brazil, China, France, Italy, UK, USA). 

 

The circumstances of low-income countries were not considered. It could be difficult for these countries with lower financial and social capital to acquire adequate amounts of Tocilizumab required for treatment.

Cost-equity

The review did not report on the cost-effectiveness of Tocilizumab.

 

Policymakers planning to endorse Tocilizumab as a form of treatment for COVID-19 need to consider the potential strain that the decision will have on the availability of Tocilizumab, and how that will affect individuals who rely on the medicine for other conditions such as rheumatoid arthritis 

 

 

Monitoring & Evaluation for PROGRESS groups

Longer term evaluation of the effectiveness of Tocilizumab for the treatment of COVID-19 is needed.

 

This study only tracks the effects of Tocilizumab for the treatment of COVID-19 over 28 days. Follow up evaluation over a longer period should be conducted in order to determine if there are any negative long-term effects, to ensure the safety.

 

 

 Comments on this summary? Please contact Jennifer Petkovic.

This summary was prepared by Obinna Ikeonu.