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Where we are with #tocilizumab for #COVID19 . Neat summary in @JAMA https://ja.ma/2IJ8HPc . The fact remains that we need good RCT data. The observational studies so far are small, flawed and show conflicting results. Given the $$$ of drug must have clearer evidence of benefit.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772186 - small trial 126 patients vs SOC = no effect . However not powered enough.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772187 Cohort embedded study, randomized with 130 patients. Again too small. Some trends towards reducing mechanical ventilation but no mortality benefit!
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772185 - 3924 patients in this cohort study. Early use of Tocilizumab within 2 days of ICU admission reduced mortality risk in treated patients.
These three studies unfortunately do not move the needle much for me where #tocilizumab is concerned for treating #covid19. More robust data are needed to justify the cost of this intervention. Till the I'm sticking with #dexamethasone as choice immunomodulator.
