Remite Ruben Piacentini By Amy Orciari Herman
– Susan Sadoughi, MD, and
– Andre Sofair, MD, MPH
The National Institutes of Health COVID-19 Treatment Guidelines Panel now recommends the interleukin-6 inhibitor tocilizumab (in addition to a corticosteroid) for certain hospitalized patients with COVID-19.
In a guideline update posted on Friday, the group advises tocilizumab (single IV dose of 8 mg per kg body weight, up to 800 mg) plus dexamethasone (6 mg a day for up to 10 days) for those who were recently hospitalized, were admitted to the ICU within the past 24 hours, and require mechanical ventilation (invasive or noninvasive) or high-flow nasal cannula oxygen. The regimen is also recommended for recently hospitalized non-ICU patients with rapidly increasing oxygen needs who require noninvasive ventilation or high-flow oxygen and have elevated inflammatory markers.
Some panel members noted that they’d also consider adding tocilizumab for hospitalized patients with rapidly increasing oxygen needs while taking dexamethasone — plus elevated inflammatory markers — who do not yet need noninvasive ventilation or high-flow oxygen. (For hospitalized patients who require conventional oxygen supplementation, the panel recommends remdesivir, dexamethasone plus remdesivir, or dexamethasone alone).
The group previously recommended against use of tocilizumab outside the ICU, and said there wasn’t enough evidence to recommend for or against its use in certain ICU patients. The new recommendations follow analysis of published results from the REMAP-CAP trial and preliminary results from the RECOVERY trial, which, the authors write, “provide consistent evidence that tocilizumab, when added to corticosteroid therapy, offers a modest mortality benefit in certain patients with COVID-19.” Late last month, the Infectious Diseases Society of America made a similar recommendation in favor of tocilizumab plus corticosteroids.
The NIH guidelines, linked below, list patient groups in whom tocilizumab should not be used (e.g., those with significant immunosuppression).
In other COVID-19 treatment news, Merck and Ridgeback Biotherapeutics reported promising results for the experimental oral antiviral molnupiravir over the weekend. In a phase 2a, placebo-controlled trial among outpatients with symptomatic COVID-19, cell culture at day 5 was negative for SARS-CoV-2 in all molnupiravir recipients — but was positive in one fourth of placebo recipients. This was a secondary endpoint from the trial. Molnupiravir is a prodrug of N4-hydroxycytidine that blocks the replication of some RNA viruses.
NIH guidelines on tocilizumab (Free) http://response.jwatch.org/tctl=9BB86:AA579CC6C4DC3B7A36385F710C06FEF1D2B71D9A95FA21D3&
Manufacturer’s news release on molnupiravir (Free) http://response.jwatch.org/tctl=9BB87:AA579CC6C4DC3B7A36385F710C06FEF1D2B71D9A95FA21D3&