AUTHOR=Mohiuddin Chowdhury Abu Taiub Mohammed , Kamal Aktar , Abbas Kafil Uddin , Talukder Shubhashis , Karim Md Rezaul , Ali Md. Ahsan , Nuruzzaman Md. , Li Yarui , He Shuixiang 

TITLE=Efficacy and Outcome of Remdesivir and Tocilizumab Combination Against Dexamethasone for the Treatment of Severe COVID-19: A Randomized Controlled Trial

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.690726

DOI=10.3389/fphar.2022.690726

ISSN=1663-9812

ABSTRACT=Objective: In this study, we investigated the efficacy and safety of Remdesivir and Tocilizumab combination therapy against Dexamethasone for the management of severe COVID-19 patients.
Methods: This was a multicentre study. Cases were randomly chosen and divided into two groups using an odd-even ratio of 1:1 applied to the hospital registration number. Group A received Remdesivir [5mg/kg (< 40kg) or 200mg (>40kg) on day1, then 2.5mg/kg (<40kg) or 100mg (>40kg) Daily] + Tocilizumab [8mg/Kg up to 800mg highest 12 hours apart], and group B was the control and received Dexamethasone 6mg/day. Additionally, a broad-spectrum antibiotic and other essential treatments were received by all patients. To evaluate the mortality risk Sequential organ failure assessment (SOFA) score was calculated on day-1. Treatment outcomes were measured as Time to Clinical Improvement; mortality rate; duration of ICU stay; total period of hospitalization; the rate of supplementary oxygen use; the time to clinical failure; National Early Warning Score-2 (NEWS), and the percentage of lung recovery on CT chest on discharge. Clinical trial registration ID: NCT04678739. 

Results: Remdesivir-Tocilizumab group had a lower mortality rate (25.49%) than the control (30.77%). The time to clinical improvement (Group A-9.41, B-14.21 days), NEWS-2 on discharge (Group A-0.89, B-1.2), duration of ICU stay (Group A-7.68, B-10.58), and the duration of hospitalization (Group A-9.91, B-14.68) were less in the treatment group. Group A had a better percentage of lung recovery on chest CT than the control (Group A-22.13, B-11.74). All these differences were statistically significant (p= <0.05) in a t-test. However, no significant survival benefit was found among the study groups in Kaplan Meier survival analysis, p=0.739.
Conclusion: The Remdesivir-Tocilizumab combination likely has preferable outcomes compared to the Dexamethasone therapy for the treatment of severe COVID-19 disease concerning mortality rate, clinical and pulmonary improvement; although did not demonstrate a significant survival benefit.