DO COVID-19 PATIENTS BENEFIT FROM TOCILIZUMAB AT ALL?

Arpan Banerjee, University of Calcutta

Since the time Covid-19 has plagued the entire world, many studies have evolved emphasizing its heterogeneous clinical presentation, ranging from silent asymptomatic carriers to the severe ones bogged down with respiratory failure. The clinical trials about the finding of the wonder drug is still awaited. In the meantime, several drugs have risen to prominence whereas many others got shackled.

One of the studies in JAMA Internal Medicine focused on the effectiveness of Tocilizumab on Covid-19 patients. Tocilizumab is an immunosuppressor which, especially, is an answer to rheumatoid arthritis and systemic juvenile idiopathic arthritis. This humanized monoclonal antibody targets the IL-6 receptor (IL-6R). IL-6 plays a pivotal role in the immune response system as well as in the pathogenesis of diseases. JIM studies reveal that 27% of the patients administered with Tocilizumab died within a month. Quite on the contrary, the scenario entailing no drug administration showed higher mortality rates to 37%. Tocilizumab has been found promising in devouring the cytokine storm quite common in the patients.

Though Dr. David Leaf expressed uncertainty to most of the randomized cases involving a different spectrum of drugs as they are not large enough to promise survival benefit. He along with 67 other hospitals across the U.S. examined over 4000 critical patients. This collaboration has resulted in the publication of several reports including the enhanced risks of heart attacks in the Covid-19 patients even when they are subjected to CPR. Most of his studies encompass the idea that Tocilizumab efficacy is at its peak when administered to the patients who have been admitted to the Intensive Care Unit (ICU) within two to three days of the emergence of the probable symptoms. Delaying the procedure would only invite irreversible organ failure and low or nil drug efficacy. Dr. Leaf et al has compared steroid usage to specific drug administration in the light of Covid-19 infection. They concluded that the steroids, much like a sledgehammer, target the entire immune system, i.e., lack system specificity while drugs like Tocilizumab focus on a single interleukin receptor molecule to function. 

It is generally injected intravenously and demands a second dosage if required later. The World Health Organization (WHO) in a result which is still in its infancy, found that drugs like remdesvir, hydroxychloroquine, lopinavir, and interferon have no surpassing substantial benefits for the patients. Although Dr. Rajesh Gandhi from Massachusetts General Hospital does not find remdesvir to be completely ineffective in the treatment of Covid-19 patients.

This has led to the documentation of another finding that unveils the inept facet of Tocilizumab. To substantiate the results, researchers from Massachusetts General Hospital studied 243 patients admitted with a temperature of over 38 degrees Celsius and pneumonia on the other end. Out of the entire lot, two-thirds received the drug and the others a placebo. The preliminary notion was that the drug would make the patients less prone to resort to the ventilators until it was inferred that there is no marked difference between them. However, this exposition contradicted the results drawn from the open-label trials and non-randomized cases which reported that these drugs are quite efficacious.

Also read: Can SARS-Cov-2 be neutralized potently, using engineered ACE2 receptor traps?

References:

1. https://www.usatoday.com/story/news/health/2020/10/20/arthritis-drug-tocilizumab-shown-effective-sickest-covid-patients/3650814001/
2. https://www.medicaldaily.com/covid-19-tocilizumab-doesnt-decrease-need-ventilator-456912

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