Remdesivir-Tocilizumab May Be Preferable to Dexamethasone for Severe COVID-19

In patients with severe COVID-19, mortality was lower, clinical improvement faster, and intensive care unit (ICU) and hospital stays shorter with combination remdesivir-tocilizumab treatment compared with dexamethasone, according to a study published in Frontiers in Pharmacology.

“[Until] now, though outcomes had been reported separately regarding an antiviral such as remdesivir and an anti–interleukin-6 receptor monoclonal antibody, such as tocilizumab, no study has been performed regarding the combined efficacy of remdesivir and tocilizumab on severe COVID-19 patients,” researchers wrote.   

The study included 205 patients admitted with severe COVID-19 to ICUs at 3 hospitals in Bangladesh. Patients were randomized to either combination remdesivir and tocilizumab therapy or dexamethasone, which served as a control. All patients also received a broad-spectrum antibiotic and other essential treatments. Patients on ventilator support or with severe comorbidities were excluded.

The mortality rate for the remdesivir-tocilizumab group was 25.49% compared with 30.77% for the dexamethasone group, according to the study. Also lower in the remdesivir-tocilizumab group was time to clinical improvement (9.41 days compared with 14.21 days for the dexamethasone group), National Early Warning Score-2 on discharge (.89 compared with 1.2), duration of ICU stay (7.68 days compared with 10.58 days), and duration of hospitalization (9.91 days compared with 14.68 days). The remdesivir-tocilizumab group also had a higher percentage of lung recovery per computed tomography scan of the chest compared with the dexamethasone group: 22.13% vs 11.74%.

Kaplan–Meier survival analysis revealed no significant survival benefit with remdesivir-tocilizumab over dexamethasone. Hazard ratios for survival were 1.089 for the remdesivir–tocilizumab group and .918 for the dexamethasone group.

Nevertheless, study outcomes with combination remdesivir-tocilizumab were in line with previous studies that investigated remdesivir and tocilizumab independently for the management of COVID-19, researchers pointed out.

“Therefore, the remdesivir–tocilizumab combination might be a preferable choice of treatment for the management of severe COVID-19,” the authors wrote. “Further study with a larger sample size is necessary to solidify the outcome of this combination.”

Reference:
Mohiuddin Chowdhury ATM, Kamal A, Abbas KU, et al Efficacy and outcome of remdesivir and tocilizumab combination against dexamethasone for the treatment of severe COVID-19: a randomized controlled trial. Front Pharmacol. 2022;13:690726. doi:10.3389/fphar.2022.690726