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Mariette X, Hermine O, Tharaux P, et al. Effectiveness of Tocilizumab in Patients Hospitalized With COVID-19: A Follow-up of the CORIMUNO-TOCI-1 Randomized Clinical Trial. 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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