Covid Deaths Lowered in Trial of Tocilizumab and Sarilumab

“Organizations are encouraged to consider prescribing tocilizumab or sarilumab when treating patients admitted to intensive care with Covid-19 pneumonia,” the new guidelines from the UK health authorities read. Dr. Gordon noted that this is the strongest official advice issued to date on the pair of immune drugs.

Some experts outside the UK are more cautious. Both Dr. Schwartz and Dr. Kaplan-Lewis noted that while the data may be sufficient to convince the FDA to approve tocilizumab and sarilumab for emergency use in the US, the jury is still ignorant of these drugs. And Dr. Boghuma Kabisen Titanji, an infectious disease doctor at Emory University, pointed out that only about 4 percent of the study’s volunteers were identified as black, making the findings potentially less applicable to the general population given the increased vulnerability of color communities to Covid19.

More studies will be needed to clarify when and in which patients tocilizumab and sarilumab work best and why their benefits were seen clearly in some studies but not in others, said Dr. Chaplain Lewis. It’s also difficult to compare studies that have now been published with previous studies that were done when the virus was much less understood, treatments were distributed with less expertise, and death rates were even higher.

“If patients received better supportive care, their outcomes could potentially improve significantly,” said Dr. Krutika Kuppalli, an infectious disease doctor at the Medical University of South Carolina who was not involved in the study. “Yes, therapeutics are helpful. But it is also about improving the standard of care for people. “

The new study and others have suggested that the window of opportunity for drugs is tight – within the first day or so of being admitted to an intensive care unit, said Dr. Chaplain Lewis. Given too early, the drugs may not have a measurable impact on the immune response. delivered too late and the damage may already have been done. “Maybe it is when a person has just started to be critical,” she said.

This turning point is not always easy to define. Patients go to intensive care in different states, and the critical illness threshold may not be the same in all hospitals. And like all other immunosuppressants, tocilizumab and sarilumab can increase the risk of infection from other viruses or bacteria.

The data are “encouraging,” said Dr. Kuppalli. “But I think we need to understand why this data looks different from other studies before we start implementing this as a widespread policy.”

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