EFFICACY OF REMDESIVIR VERSUS REMDESIVIR PLUS TOCILIZUMAB IN MODERATE TO SEVERE COVID-19 PATIENTS ADMITTED IN THE CRITICAL CARE UNIT OF A TERTIARY CARE HOSPITAL IN WEST BENGAL, INDIA

Abstract

Background And Aims: Severe corona virus infection is often associated with hyper immune response and liberation of inammatory cytokines. Anti-interleukin-6 receptor monoclonal antibody like tocilizumab might be effective in corona virus infection. Present study was designed to assess the effect of adding tocilizumab to remdesivir and other supportive therapy in management of critically ill covid-19 patients. Methods: This Randomized open-level clinical trial was done in 50 critically ill Covid-19 patients (from December 2020 to February 2021). They were randomly allocated in two group; to receive either injection remdesivir (Group R) or injection remdesivir plus tocilizumab (Group RT) intravenously. Patients were assessed using daily record sheets capturing data on the six-category ordinal scale and safety prole from day-1 to day28 or discharge or death. Other clinical data were recorded using the WHO International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) case record form. Primary endpoint with respect to the efcacy of the drugs was based on proportion of patients achieving clinical improvement dened as a two point reduction in six point ordinal scale from patients admission status or live discharge from the hospital, which ever came rst. Results: Baseline characteristics were identical in both R and RT group. Biomarkers, C reactive protein, IL-6 and serum ferritin levels were signicantly more in RT group as compared to R group on day 1,3 and 7. But C reactive protein (CRP), serum ferritin and IL-6 levels from day 1 to day 7 gradually decreased in RT group and increased in R group. Conclusion: In spite of higher levels of biomarkers morbidity and mortality of patients did not increase in RT group; use of tocilizumab might be responsible for the gradual reduction in the level of biomarkers in this group.