UMEM Educational Pearls

Category: Critical Care

Title: The RECOVERY Trial: Tocilizumab in COVID-19

Keywords: COVID-19, tocilizumab, ICU, mechanical ventilation (PubMed Search)

Posted: 5/11/2021 by Lindsay Ritter, MD (Updated: 10/21/2021)
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Takeaways

RECAP: RECOVERY trial is a large, randomized, open label, adaptive trial studying different treatments on COVID-19. Most well known is the use of dexamethasone which reduced mortality by 1/3 in COVID patients requiring mechanical ventilation and by 1/5 in those requiring oxygen, with no benefit on those patients not requiring oxygen.

They recently published results in the Lancet on the use of tocilizumab. 

Population: 

  • Up to 21 days after main randomization, regardless of treatment, RECOVERY trial patients with progressive COVID-19 were eligible for tocilizumab. 

Inclusion: 

  • April 23rd 2020 to Jan 24th 2021-- 21,550 patients with hypoxia (<92% on RA or requiring O2), systemic inflammation (CRP > 75 mg/L) eligible for standard care or standard care plus toci 400-800 mg (dosing based on weight), second dose 12-24 hours later if no improvement

Outcomes: 

  • Primary outcome 28 day mortality followed by:
  • Hospital discharge within 28 days
  • Rate of mechanical ventilation 

Results: 

  • 621 (31%) tocilizumab patients and 729 (35%) of usual care patients died within 21 days (RR 0.85, p=0.0028). Consistent even in those receiving steroids (83%).
  • Tocilizumab group more likely to be discharged from the hospital, less likely to receive invasive mechanical ventilation (35% vs 42%).

Conclusion: 

  • Tocilizumab improved survival and other clinical outcomes- by 1/3 for those on simple oxygen, and by ½ for those receiving invasive mechanical ventilation.
  • Added to the additional benefit of steroids. 
  • Findings support the earlier REMAP-CAP trial on the effectiveness of tocilizumab for ICU COVID patients 

 

In-Depth

References

RECOVERY Collaborative Group Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021; 3971637-1645