Effectiveness of Tocilizumab in Patients Hospitalized With COVID-19: A Follow-up of the CORIMUNO-TOCI-1 Randomized Clinical Trial | Critical Care Medicine | JAMA Internal Medicine | JAMA Network
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    Research Letter
    May 24, 2021

    Effectiveness of Tocilizumab in Patients Hospitalized With COVID-19: A Follow-up of the CORIMUNO-TOCI-1 Randomized Clinical Trial

    Author Affiliations
    • 1Department of Rheumatology, Hôpital Bicêtre, Assistance Publique–Hôpitaux de Paris, Le Kremlin Bicêtre, France
    • 2Université Paris-Saclay, Institut national de la santé et de la recherche médicale (INSERM) UMR1184, Le Kremlin Bicêtre, Le Kremlin Bicêtre, France
    • 3Department of Hematology, Hôpital Necker, Assistance Publique–Hôpitaux de Paris, Paris, France
    • 4Institut Imagine, Université de Paris, INSERM UMR1183, Paris, France
    • 5Paris Cardiovascular Center, Université de Paris, INSERM, F-75015 Paris, France
    • 6Université de Paris, ECSTRRA Team, Centre of Research Epidemiology and Statistics, INSERM UMR1153, Paris, France
    • 7URC Saint-Louis, Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
    • 8Department of cardiology, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
    • 9Université de Paris, INSERM U1148, Paris, France.
    • 10Université de Paris, Centre of Research Epidemiology and Statistics, INSERM U1153, Paris, France
    • 11Centre d’Epidémiologie Clinique, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France
    JAMA Intern Med. Published online May 24, 2021. doi:10.1001/jamainternmed.2021.2209

    Eight randomized clinical trials of tocilizumab for treating patients with COVID-19 have reported heterogeneous results.1-6 Although 4 of them achieved their primary end point, improved 28-day survival was demonstrated only in the 2 largest studies and those with the highest mortality, RECOVERY1 and REMAP-CAP.2 Moreover, only RECOVERY enrolled only patients with elevated C-reactive protein (CRP) levels. The RECOVERY and REMAP-CAP trials involved a high rate of patients using dexamethasone (>80% of the patients in both treatment arms). Differences in trial outcomes may be associated with differences in power, populations, design, management, or length of follow-up.

    We previously published a trial of tocilizumab in hospitalized patients who were receiving oxygen (rate, ≥3 L/min) but did not require high-flow or mechanical ventilation.3 The study met its primary composite end point, which was the proportion of patients who required noninvasive ventilation or intubation or who died at day 14, but found no survival difference at day 28. In this follow-up article, we extended follow-up to 90 days and examined whether survival varied with baseline CRP levels.

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