Two recent studies found some positive outcomes with tocilizumab treatment for COVID-19. An Italian study, published by The Lancet Rheumatology on June 24, compared 179 patients with severe COVID-19 who received IV or subcutaneous tocilizumab to 365 treated with standard care. The mortality rate was 20% in the standard care group compared to 7% with tocilizumab (P<0.0001). After adjustment, tocilizumab was associated with a reduced risk of invasive mechanical ventilation or death (adjusted hazard ratio, 0.61; 95% CI, 0.40 to 0.92; P=0.020). The authors noted that a major concern with this drug is the risk of adverse events, and the rate of new infection was significantly increased in the intervention group (13% vs. 4%). They concluded that the study's results are encouraging but should be confirmed by randomized trials, which are currently ongoing.
The other study, published by Clinical Infectious Diseases on June 23, followed 27 hospitalized patients in California who received a single dose of tocilizumab on a compassionate-use basis. The patients had reductions in inflammatory markers, including C-reactive protein and temperature, as well as improvement in oxygenation and reduction in need for vasopressor support. “Our early experience with tocilizumab suggests that targeted treatment against cytokine storm related to SARS-CoV2 infection may lead to clinical improvement, recovery from respiratory failure, and prevention of death,” the authors said, although they cautioned that placebo-controlled data is needed for proof of efficacy.
Another recent study, published by JAMA Network Open on June 24, suggested benefit from colchicine for patients hospitalized with COVID-19. The Greek trial randomized 55 patients to open-label treatment with colchicine (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) and compared their outcomes to 50 patients receiving standard care. Those on colchicine had statistically significantly improved time to clinical deterioration, but no significant differences in troponin or C-reactive protein levels, compared to controls. The authors of the study and an accompanying editorial cautioned that the results should be considered hypothesis generating. However, they “suggest that colchicine is safe and may improve outcomes in patients with COVID-19,” the editorial said.
In other COVID-19 research, the results of a national French survey, published by Clinical Infectious Diseases on June 18, described symptoms in patients ages 70 years and older. More than half of patients exhibited three or fewer symptoms in the first 72 hours of illness, with the most common being thermal dysregulation (83.6%), cough (58.9%), asthenia (52.7%), polypnea (39.9%), and gastrointestinal signs (24.4%). A comparison of those younger and older than age 80 years found that falls and sudden deterioration of general condition were more common in the oldest patients, whereas fever was less common. “These findings should be integrated into the clinical reasoning in geriatric medicine, and encourage the systematization of diagnostic tests for SARS-Cov-2 infection in older adults,” the authors said.
Another study, published by The Lancet Psychiatry on June 25, used a British database to analyze neurological complications. Of 125 neurological presentations of COVID-19 reported by clinicians in the U.K., 62% were a cerebrovascular event (74% of which were ischemic stroke). Thirty-one percent of the reported cases presented with altered mental status (23% with unspecified encephalopathy, 18% with encephalitis, and 59% with psychiatric diagnoses). About half of the patients with altered mental status were younger than age 60 years, whereas only 18% of those with cerebrovascular events were.