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UM study: Immunosuppressive drug associated with lower risk of death in COVID-19 patients

Patients on ventilators who received a single dose of tocilizumab had lower mortality rate

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ANN ARBOR – A new study from researchers at the University of Michigan has found that critically ill COVID-19 patients on ventilators were 45% less likely to die overall if they received a single dose of a drug that suppresses overreacting immune systems. 

The study suggests that patients benefit from receiving tocilizumab, an immunosuppressive drug used to treat rheumatoid arthritis, in targetted efforts intravenously to reduce the “cytokine storm,” a period of time when the body attacks its own cells and tissues.

Published in the journal Clinical Infectious Diseases, the study showed that patients were more likely to leave the hospital or stop the use of a ventilator one month after treatment with the drug, even though they had double the risk of developing another infection in addition to the coronavirus.

For the study, U-M researchers used data from 154 critically ill Michigan Medicine patients from early March to late April to formulate their conclusions. About half of the patients who received tocilizumab got it within the 24 hours around being put on a ventilator. 

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Tocilizumab was identified as a potential therapy for severely ill COVID-19 patients by the Michigan Medicine Antimicrobial Stewardship Program but due to associated risks and lack of evidence in fighting the coronavirus, some physicians did not use it, according to Michigan News.

This led to a natural division in patients, which allowed researchers to do their observational study but clinical trials are needed.

Jason Pogue, an author of the study and an infectious disease pharmacist at Michigan Medicine, told Michigan News that one dose of tocilizumab is about 100 times more expensive than an entire course of dexamethasone, a steroid also used as a COVID-19 treatment. Pogue said further studies are needed to see how tocilizumab works when compared to other, cheaper drugs or how it could work in tandem with them.

Many of the patients in the study were brought to Michigan Medicine from the Detroit-area after their COVID-19 diagnosis. At the end of 28 days after patients were put on a ventilator, 36% of patients of non-tocilizumab and 18% of tocilizumab patients died.

For patients still at the hospital at the end of the study, 82% of tocilizumab patients and 53% of non-tocilizumab patients stopped using a ventilator. However, just over half of the tocilizumab patients developed an additional infection but only 26% of non-tocilizumab patients did. 

Hydroxychloroquine, a drug also studied as a possible COVID-19 treatment, was included in COVID-19 treatment guidelines at Michigan Medicine for two-and-a-half weeks in the study period, according to Michigan News. It was only given to 25% of tocilizumab patients and 20% of non-tocilizumab patients. It was removed from Michigan Medicine’s treatment guidelines for COVID-19 inpatients.

The study is authored by several members of the University of Michigan Medical School, the U-M College of Pharmacy, School of Public Health, and the Michigan Institute for Clinical and Health Research.

It was supported by the National Institutes of Health, the Centers for Disease Control and Prevention, and a New Investigator Award by the American Society for Transplantation and Cellular Therapy.

Find the study, “Tocilizumab for treatment of mechanically ventilated patients with COVID-19,” here. 


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