Tociluzimab ineffective in COVID-19......

3,603 Views | 18 Replies | Last: 3 yr ago by culdeus
Marcus Aurelius
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12:41p, 10/22/20
AG
https://www.nejm.org/doi/full/10.1056/NEJMoa2028836?query=featured_home

Bummer. I wanted it not to be true. But my gut lately felt this to be the case. Anecdote - but it seems it was more effective in the beginning of this disaster. Not so much lately. I haven't used it in mos. Dexamethasone likely playing a role in that. Disclaimer however - some flaws in this study with wide confidence intervals.
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Aggie95
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12:47p, 10/22/20
AG
Hearing Remdisivir is also not effective as previously thought.
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plain_o_llama
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In reply to Marcus Aurelius • 12:57p, 10/22/20
What does the Covid hospital toolkit include at the moment?
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Marcus Aurelius
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In reply to plain_o_llama • 1:03p, 10/22/20
AG
dex, CVP, anticoagulation, avoid vent, proning, accept lower sats.
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Keegan99
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In reply to Marcus Aurelius • 2:09p, 10/22/20
AG
Surprising. Seen to recall you had at least one pt where you were certain toci saved his life given the rapid and stark results.
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Marcus Aurelius
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In reply to Keegan99 • 2:49p, 10/22/20
AG
Multiple actually. But - that's why we do DBRPCTs.
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AgResearch
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In reply to Aggie95 • 3:28p, 10/22/20
AG
Aggie95 said:
Hearing Remdisivir is also not effective as previously thought.
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Aggie95
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In reply to AgResearch • 4:06p, 10/22/20
AG
Watched a dr the other day say multiple recent studies contradict early reports of its success.
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Marcus Aurelius
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7:21p, 10/22/20
AG
Re remdesivir. NEJM published paper showed reduced recovery time. Other studies including Jama paper showed no benefit. It did get FDA approval. We are using it. Requires ID approval. It is being used less here.
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Dr. Not Yet Dr. Ag
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9:44p, 10/22/20
Pre-print RCT data provided today demonstrating convalescent plasma failed to show mortality benefit or progression of disease benefit.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Infection_Ag11
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In reply to Marcus Aurelius • 9:55p, 10/22/20
AG
Yeah I had high hopes for toci

Unfortunate
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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amercer
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In reply to Dr. Not Yet Dr. Ag • 10:03p, 10/22/20
AG
Dr. Not Yet Dr. Ag said:
Pre-print RCT data provided today demonstrating convalescent plasma failed to show mortality benefit or progression of disease benefit.


Unfortunate, but maybe not surprising. How much plasma do you give per patient? Google tells me that total IgG per ml is 70mg or so. The Regeneron cocktail is 8 Grams of high affinity anti Covid IgG.

Plus, antibody treatment is probably only effective early.
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Pelayo
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In reply to Marcus Aurelius • 11:16p, 10/22/20
AG
Marcus Aurelius said:
Multiple actually. But - that's why we do DBRPCTs.
CI were very wide and results not s.s.

What do you think of the inclusion and exclusion criteria? At what point did you pull the trigger, any set O2 requirement etc, and what has changed in the average presentation over months that has you using it less?
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Marcus Aurelius
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In reply to Pelayo • 11:12a, 10/23/20
AG
We had ferritin > 1000, CRP > 200 as requisites for toci. So sicker population. Hospital cracked down on it several mos ago. I couldn't get it. The pre print of this paper was available a mo ago. Hospital was all over it. $$$$$$$$$$$$$ as usual. For profit hospital.
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culdeus
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11:50a, 10/23/20
AG
What else is being watched? Lemorilab?
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Pelayo
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In reply to Marcus Aurelius • 1:40p, 10/23/20
AG
Marcus Aurelius said:
We had ferritin > 1000, CRP > 200 as requisites for toci. So sicker population. Hospital cracked down on it several mos ago. I couldn't get it. The pre print of this paper was available a mo ago. Hospital was all over it. $$$$$$$$$$$$$ as usual. For profit hospital.
Not surprised. Thanks.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Diyala Nick
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In reply to culdeus • 8:46p, 10/23/20
AG
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AgsMyDude
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In reply to Marcus Aurelius • 6:55p, 11/19/20
AG
Marcus, have you seen this yet?

https://www.recover-europe.eu/tocilizumab-effective-in-treating-sickest-covid-19-patients/

Quote:
The early findings, which are yet to be published, come from the REMAP-CAP trial, sponsored by the UMC Utrecht in Europe and led by Imperial College London and ICNARC in the UK. They show that treatment with the immune modulator tocilizumab was 99 per cent more likely to reduce deaths and time spent in intensive care among critically ill patients with severe COVID-19, compared to patients
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Marcus Aurelius
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In reply to AgsMyDude • 7:13p, 11/19/20
AG
No. Thx. Spot on IMO - see the above comments. The negative paper looked at less sick pts. Frustrating and I still believe it helps the sickest cytokine storm pts.
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culdeus
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In reply to culdeus • 10:26p, 2/14/21
AG
culdeus said:
What else is being watched? Lemorilab?


Looks very likely to be approved this week.
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