Covid-19 Living Data

Trial NCT04412291, EudraCT 2020-001748-24
Publication IMMCOVA - IMMCOVA, Unpublished (2021) (unpublished results)

Funding: Public/non profit (Karolinska University Hospital)
Conflict of interest: *

Methods
	RCT Blinding: Unblinded
	Location : Multicenter / Sweden Follow-up duration (days): 28
Inclusion criteria	Age ≥18 years Laboratory-confirmed SARS-CoV-2 infection as determined by polymerase chain reaction (PCR) or other commercial or public health assay < 7 days prior to screening SARS-CoV-2 infection with duration at least 7 days (i e may be included on day 7) as determined by onset of symptoms (defined as day 1) 5 liters/minute of Oxygen for at least 8 hours to maintain SpO2 at ≥93%. A shorter duration is also accepted if presentation is acute, and the patient needs more than 10 liters/minute of Oxygen, or high flow nasal cannula or non-invasive ventilation, to maintain SpO2 at ≥93% CRP > 70 mg/L with no non-SARS-Cov2 infections. Values measured up to 48 hours before inclusion are accepted Ferritin > 500 µg/L Values measured up to 48 hours before inclusion are accepted At least two points on a scale of 0-3 where 1 point is awarded for each value of lymphocytes < 1x 10(9)/L D-dimer ≥ 0.5 mg/L and Lactate Dehydrogenase ≥ 8 microkatal/L. The values do not have to be concurrently positive and may be up to 3 days old at inclusion Ability to provide informed consent signed by study patient Willingness and ability to comply with study-related procedures/assessments In fertile females, willing to comply with effective contraceptive methods for up to 3 months after last dose of study drug. These may include surgical sterilization of patient or partner, intrauterine device or condoms. Gestagen-only birth control pills (mini-pills), which do not increase the risk of deep venous thrombosis, may also be used. Non-fertile woman is defined as more than 12 months of amenorrhea without an alternative medical cause or, in case of ambiguities, an FSH level in the postmenopausal range.
Exclusion criteria	Pregnancy or breast feeding Ongoing or completed mechanical ventilation In the opinion of the investigator, unlikely to survive for >48 hours from screening In the opinion of the investigator, expected overall survival due to other comorbidities less than 3 months Severe renal dysfunction eGFR < 30 ml/min Medical history including chronic liver disease with inflammation, fibrosis or cirrhosis including underlying diseases such as alcoholic liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis, alcoholic liver disease, autoimmune liver disease, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, cholangitis, or carcinoma Uncontrolled hypertension Systolic BP >180 mm Hg, Diastolic BP > 110 mm Hg History of hypersensitivity to the study drugs Presence of any of the following abnormal laboratory values at screening: absolute neutrophil count (ANC) less than 2 x 109/L, aspartate aminotransferase (AST) or alanine aminotransferase (ALT) greater than 5 x upper limit of normal (ULN), platelets <100 x 109/L Treatment with anakinra, anti-IL 6, anti-IL-6R antagonists, Janus kinase inhibitors (JAKi) in the past 30 days or plans to receive during the study period Current treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs)/immunosuppressive agents Use of chronic oral corticosteroids for a non-COVID-19-related condition in a dose higher than prednisone 10 mg or equivalent per day. Ongoing acute treatment for COVID-19 with any peroral or iv steroid is permitted for up to five days before inclusion. Chronic or acute treatment with inhaled steroids is also permitted History of, or current autoimmune or inflammatory systemic or localized disease(s) other than rheumatoid arthritis Acute systemic infection verified by blood cultures systemic bacterial infection, systemic fungi-infection or prosthesis-related infection History of stem-cell or solid organ transplantation Known active tuberculosis (TB), history of incompletely treated TB, suspected or known extrapulmonary TB, suspected or known systemic bacterial or fungal infections Diagnosis of, or suspicion of HIV infection, acute hepatitis A and/or chronic hepatitis B and/or C Previous history of gastrointestinal ulceration or diverticulitis. Patients who have received immunosuppressive antibody therapy within the past 3 months, including intravenous immunoglobulin or plans to receive during the study period Participation in any clinical research study evaluating an investigational product (IP) or therapy within 3 months and less than 5 half-lives of IP prior to the screening visit. The use of remdesivir is permitted. Any physical examination findings and/or history of any illness that, in the opinion of the study investigator, might confound the results of the study or pose an additional risk to the patient by their participation in the study
Interventions
	Treatment Tocilizumab 8 mg/kg (max 800mg) IV single dose
	Control Standard care
Participants
	Randomized participants : Standard care=27 Tocilizumab=22
	Characteristics of participants N= 49 Mean age : NR 37 males Severity : Mild: n=0 / Moderate: n=0 / Severe: n=49 Critical: n=0 Number of vaccinated participants: NR
Primary outcome
	In the register Time to recovery [ Time Frame: Day 1 through Day 29 ]
	In the report NR
Documents available	Protocol NR Statistical plan NR Data-sharing willing stated in the publication: Not reported
Risk of bias Overall The overall risk of bias reported in the table corresponds to the highest risk of bias for the outcomes assessed for the systematic review	Low
General comment	The study is not published yet. Data presented was extracted from study registry and The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group "Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis." JAMA. 2021;326(6):499–518. ).The authors have been contacted in order to obtain the results.