what can we expect from it?

September 23, 2022

A communication without raw data from the Public Assistance-Hospitals of Paris suggests that tocilizumab could be useful in severe cases of Covid-19. What can we expect from this medication?

The Public Assistance-Hospitals of Paris (AP-HP), in a statement, states that tocilizumab would be effective in limiting the use of ventilation and the number of deaths at 14 days in patients Covid-19 severe but without any raw data being provided. It will be necessary to wait for the publication of the study in the medical literature to judge the quality of the experience. Using previous data, what can we reasonably expect from tolicizumab?

What is tolicizumab?

Tocilizumab is an antibody monoclonal humanized recombinant which acts as a antagonist receptorsinterleukin (IL) -6. In other words, it's a molecule which inhibits the body's inflammatory response. It is mainly used and authorized in patients with rheumatoid arthritis in order to reduce theinflammation overall chronic of the organism.

This drug is expensive and difficult to produce, unlike chloroquine. However, this is not a relevant criterion for judging whether or not it is effective within covid-19.

The mechanisms behind this therapy

The logic behind clinical tests testing tocilizumab is the reduction the famous citokynic storm which occurs in some patients with severe form of the disease. In fact, in these patients seriously infected with SARS-CoV-2, sometimes falls down storm inflammatory molecules in response to infection. Epithelial cells are infected with the virus, cell permeability increases, this in order to fight infection.

But, by mechanisms still poorly identified, this strategy degenerates and the immune system over-reacts, leading to the failure of certain vital organs and the death of the patient. Interleukin-6, citokine inhibited by tocilizumab, plays a major role in this thunderstorm. This is why tocilizumab is tested. We hope, thanks to him, to prevent the dreaded cytokine storm.

What can we expect from tocilizumab?

Small experiences have already occurred with tocilizumab. None of them meet the standards of clinical trials, so it is difficult to draw clinical recommendations. The AP-HP communication suggests a rigorous publication (randomized trial and multi-centric) but, for the moment, the publication is not available. It is therefore impossible to know what it is worth both methodologically and in terms of results.

In addition, Sanofi laboratories communicated on ongoing studies concerning tocilizumab and show more mixed preliminary results. Currently, around thirty clinical trials are registered for tocilizumab in application against Covid19. In this story, before yelling " game over ", you will still have to be careful.

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