Treatment

NIH Updates Tocilizumab Guidelines

The COVID-19 Treatment Guidelines Panel has updated its recommendations for the use of tocilizumab to treat COVID-19 in certain patient populations.

This recommendation comes as an update to the Panel’s prior recommendations that utilized the preliminary results of the Randomized, Embedded, Multifactorial Adaptive Platform Trial (REMAP-CAP). In this new update, the Panel evaluated the published results of the REMAP-CAP trial as well as the preliminary results from the Randomized Evaluation of COVID-19 Therapy trial (RECOVERY).

Tocilizumab is recommended for use in a single intravenous dose of 8 mg/kg of body weight, up to 800 mg. Tocilizumab is recommended to be used in combination with dexamethasone, 6 mg daily, for up to 10 days. This recommendation is intended for use in the following patient populations:

  • Patients who have been recently hospitalized and admitted to the intensive care unit within the prior 24 hours and who require invasive mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal canula
  • Patients who have been recently hospitalized and have not been admitted to the intensive care unit, with rapidly increased oxygen needs who require noninvasive mechanical ventilation or high-flow nasal canula and have significantly increased markers of inflammation

 

This update also recommends the use of remdesivir, dexamethasone in combination with remdesivir, or dexamethasone alone for patients who have been hospitalized and require conventional oxygen supplementation. The addition of tocilizumab is not specified for this patient population, as there is insufficient evidence to support potential benefits.

“The results of the RECOVERY and REMAP-CAP trials provide consistent evidence that tocilizumab, when added to corticosteroid therapy, offers a modest mortality benefit in certain patients with COVID-19 who are severely ill and exhibit rapid clinical deterioration with increasing oxygen needs and a significant inflammatory response to the virus. However, the Panel found it challenging to define the specific population(s) that would benefit from this intervention,” the Panel concluded.

 

­—Leigh Precopio

 

Reference:

COVID-19 Treatment Guidelines Panel. Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Published online March 5, 2021. https://www.covid19treatmentguidelines.nih.gov/statement-on-tocilizumab/