Friday, February 12, 2021

Toci + Dexa for COVID

PulmCrit (EMCrit)
PulmCrit - February 12, 2021 - By Josh Farkas
“Summary: The Bullet
  • Among hypoxemic COVID patients with CRP >75 mg/L, adding tocilizumab on top of dexamethasone 6 mg/day improves mortality and other important endpoints (e.g., reductions in intubation and hemodialysis).
  • Evidence suggests that tocilizumab monotherapy is ineffective, but tocilizumab provides benefit when added to steroid. This may explain the success of RECOVERY and REMAP-CAP, in comparison to prior studies of tocilizumab which didn’t detect benefit.
  • The key factor in selecting patients who may benefit from tocilizumab seems to be the presence of systemic inflammation (CRP >75 mg/L), rather than illness severity or timing. 
  • If tocilizumab is unavailable, other immunomodulators may be considered in its place. Higher doses of steroid, or JAK-inhibitors combined with steroid are supported by some evidence in COVID and might be rational therapies here (albeit with less robust evidentiary support). 
  • 6 mg dexamethasone daily is inadequate for sicker patients with COVID pneumonia”