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

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To identify the key insights or developments described in this article
1 Credit CME

Eight randomized clinical trials of tocilizumab for treating patients with COVID-19 have reported heterogeneous results.16 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.

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Article Information

Accepted for Publication: March 31, 2021.

Published Online: May 24, 2021. doi:10.1001/jamainternmed.2021.2209

Corresponding Author: Xavier Mariette, MD, PhD, Department of Rheumatology, Hôpital Bicêtre, 78 Av du Général Leclerc, 94275, Le Kremlin Bicêtre, France (xavier.mariette@aphp.fr).

Correction: This article was corrected on June 28, 2021, to fix an incorrectly named scale in the Results.

Author Contributions: Drs Porcher and Resche-Rigon had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mariette, Hermine, Tharaux, Resche-Rigon, Ravaud.

Acquisition, analysis, or interpretation of data: Mariette, Tharaux, Resche-Rigon, Steg, Porcher, Ravaud.

Drafting of the manuscript: Mariette, Hermine, Tharaux.

Critical revision of the manuscript for important intellectual content: Mariette, Resche-Rigon, Steg, Porcher, Ravaud.

Statistical analysis: Resche-Rigon, Porcher, Ravaud.

Obtained funding: Mariette, Hermine, Resche-Rigon.

Administrative, technical, or material support: Resche-Rigon, Steg.

Supervision: Mariette, Hermine, Tharaux, Ravaud.

Conflict of Interest Disclosures: Dr Steg reported personal fees from Amarin, Amgen, AstraZeneca, BMS, Idorsia, Novo Nordisk, Novartis, Pfizer, Sanofi, Servier, and Regeneron as well as grants from Bayer, Sanofi, Servier, and Amarin outside the submitted work. Dr Ravaud reported being a minority shareholder of INATO outside the submitted work. No other disclosures were reported.

Funding: This trial was publicly funded (Ministry of Health, Programme Hospitalier de Recherche Clinique [PHRC COVID-19-20-0143, PHRC COVID-19-20-0029] and Foundation for Medical Research).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge the members of the CORIMUNO-19 collaborative group.

Data Sharing Statement: See Supplement 3.

References
1.
RECOVERY Collaborative Group.  Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial.   medRxiv. Preprint posted February 11, 2021. doi:10.1101/2021.02.11.21249258Google Scholar
2.
Gordon  AC , Mouncey  PR , Al-Beidh  F ,  et al; REMAP-CAP Investigators.  Interleukin-6 receptor antagonists in critically ill patients with Covid-19.   N Engl J Med. 2021;384(16):1491-1502. doi:10.1056/NEJMoa2100433PubMedGoogle Scholar
3.
Hermine  O , Mariette  X , Tharaux  PL , Resche-Rigon  M , Porcher  R , Ravaud  P ; CORIMUNO-19 Collaborative Group.  Effect of tocilizumab vs usual care in adults hospitalized with COVID-19 and moderate or severe pneumonia: a randomized clinical trial.   JAMA Intern Med. 2021;181(1):32-40. doi:10.1001/jamainternmed.2020.6820 PubMedGoogle ScholarCrossref
4.
Stone  JH , Frigault  MJ , Serling-Boyd  NJ ,  et al; BACC Bay Tocilizumab Trial Investigators.  Efficacy of tocilizumab in patients hospitalized with Covid-19.   N Engl J Med. 2020;383(24):2333-2344. doi:10.1056/NEJMoa2028836 PubMedGoogle ScholarCrossref
5.
Salvarani  C , Dolci  G , Massari  M ,  et al; RCT-TCZ-COVID-19 Study Group.  Effect of tocilizumab vs standard care on clinical worsening in patients hospitalized with COVID-19 pneumonia: a randomized clinical trial.   JAMA Intern Med. 2021;181(1):24-31. doi:10.1001/jamainternmed.2020.6615 PubMedGoogle ScholarCrossref
6.
Salama  C , Han  J , Yau  L ,  et al.  Tocilizumab in patients hospitalized with Covid-19 pneumonia.   N Engl J Med. 2021;384(1):20-30. doi:10.1056/NEJMoa2030340 PubMedGoogle ScholarCrossref
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