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Tocilizumab combined with favipiravir in the treatment of COVID-19: A multicenter trial in a small sample size - 19/12/20

Doi : 10.1016/j.biopha.2020.110825 
Hong Zhao a, b, 1, Qi Zhu c, 1, Chi Zhang a, 1, Jiawen Li a, Ming Wei d, Yuhong Qin e, Guilin Chen c, Ke Wang d, Junhua Yu f, Zhao Wu a, Xianxiang Chen g, , Guiqiang Wang a, b,
a Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China 
b Peking University International Hospital, Beijing, China 
c Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan, 430030, China 
d Wuhan Jinyintan Hospital, No. 1 Yintan Road, Dongxihu District, Wuhan, 430040, China 
e Emergency Department of Peking University International Hospital, Life-Science Park, Changping District, Beijing, 102206, China 
f Ezhou Central Hospital, 9 Wenxing Road, Ezhou City, Hubei Province, 463000, China 
g Surgical Department, Wuhan Pulmonary Hospital, No. 28 Baofeng Road, Wuhan, 430030, China 

Corresponding author.⁎⁎Corresponding author at: Department of Infectious Diseases and Center for Liver Diseases, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.Department of Infectious Diseases and Center for Liver DiseasesPeking University First HospitalNo. 8 Xishiku Street, Xicheng DistrictBeijing100034China

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Highlights

Tocilizumab can significantly improve COVID-19’s pulmonary inflammation.
Tocilizumab can significantly improve the clinical symptoms of COVID-19 patients.
Tocilizumab combined with or without favipiravir can effectively reduce the mortality of COVID-19.

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Abstract

Background

Since December 2019, COVID-19 has spread to almost every corner of the world. In theory, tocilizumab and favipiravir are considered to be reliable drugs for the treatment of COVID-19 with elevated IL-6. We aimed to assess the efficacy and safety of tocilizumab combined with favipiravir in patients with COVID-19.

Methods

This was a multicenter trial in adults with COVID-19. Patients were randomly assigned (3:1:1) to a 14-day combination of favipiravir combined with tocilizumab (combination group), favipiravir, and tocilizumab. The primary outcome was the cumulative lung lesion remission rate (lung CT examination indicated absorption of lung inflammation).

Results

Between Feb 2 and March 15, 2020, 26 patients were recruited; 14 were randomly assigned to the combination group, 7 were assigned to the favipiravir group and 5 were assigned to the tocilizumab group. The cumulative lung lesion remission rate at day 14 was significantly higher in combination group as compared with favipiravir group (P = 0.019, HR 2.66 95 % CI [1.08–6.53]). And there was also a significant difference between tocilizumab and favipivavir (P = 0.034, HR 3.16, 95 % CI 0.62–16.10). In addition, there was no significant difference between the combination group and the tocilizumab group (P = 0.575, HR 1.28 95 %CI 0.39–4.23). Furthermore, combined therapy can also significantly relieve clinical symptoms and help blood routine to return to normal. No serious adverse events were reported.

Conclusion

Tocilizumab combined with or without favipiravir can effectively improve the pulmonary inflammation of COVID-19 patients and inhibit the deterioration of the disease.

Le texte complet de cet article est disponible en PDF.

Abbreviations : CRS, IL-6

Keywords : Tocilizumab, Favipiravir, Interleukin-6, COVID-19, SARS-CoV-2


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