Today is February 12 of 2021 and I’m gonna be discussing this new not quite yet peer-reviewed article from the recovery trial collaborative group titled “Tocilizumab for COVID-19” or it might be called “Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): Preliminary results of a randomized, controlled, open-label, platform trial.

Should we be giving one or two doses of Tocilizumab? Article shared on 10/9/21

Al Sulaiman K, Aljuhani O, Bin Salah K, Korayem GB, Eljaaly K, Al Essa M, Kharbosh A, Al Harbi F, Abuzaid M, Al Bilal S, Almagthali A, Alsohemi S, Alshabasy A, Noureldeen H, Aboudeif M, Alshehri A, Vishwakarma R. Single versus multiple doses of Tocilizumab in critically ill patients with coronavirus disease 2019 (COVID-19): A two-center, retrospective cohort study. J Crit Care. 2021 Aug 23;66:44-51. doi: 10.1016/j.jcrc.2021.08.007. Epub ahead of print. PMID: 34438133; PMCID: PMC8381723.
Link to Article
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ADDENDUM: The following article was shared on IG on 7/28/21 Titled “What every intensivist should know about Tocilizumab”

Hofmaenner DA, Wendel Garcia PD, Ganter CC, Brugger SD, Buehler PK, David S. What every intensivist should know about Tocilizumab. Crit Care. 2021 Jul 27;25(1):262. doi: 10.1186/s13054-021-03696-1. PMID: 34315504; PMCID: PMC8313874.
Link to Article
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I definitely have to tip my hat to the people who are part of this RECOVERY collaborative group because they’re the ones who came out with the data showing that dexamethasone does help save lives in patients with COVID-19. Dexamethasone is one of the only treatments that we know actually works for this for this awful virus. As always I have to give a disclaimer that you should read this article for yourself and not trust me. It’s free for you to download down below.

I hate the fact that this pandemic has already been going on for a year. We’ve had some ups and downs with regards to our numbers. Hopefully with the vaccination, the downs will continue going down and we can start seeing the light at the end of the tunnel. For the time being, I don’t know about what your ICU is looking like but my CU still has quite a few Covid patients who I’d like to save. It’s not a secret that people do extremely well with Covid but there’s a small portion of the population will get extremely sick and we can’t quite identify who’s going to get sick and who doesn’t get sick. We commonly see underlying health issues such as obesity, advanced age, hypertension, diabetes, etc. We have learned that COVID in certain people causes immense inflammation. This is what actually causes problems in majority of these patients get sick. 

We’ve heard about this cytokine storm and for those people who have these fancy lab tests that can actually measure in interleukin 1, interleukin 6, tumor necrosis factor alpha and see that these are through the roof. For those of us who work in other institutions where we did not have the funds to send out these specific inflammatory cytokines, instead he instead you know we check the D dimer, ferritin and c-reactive protein. Watch these markers go through the roof and watch our patients get sicker despite our best efforts. Like I said before we know dexamethasone works and there have been other treatments out there which I’m not going to discuss here which may or may not have some value in treating these unfortunate patients. 

Since the beginning this whole pandemic a lot of people including myself have tried different things to see what works. One of these treatments was tocilizumab. If you are following along on my Instagram, my webpage, or this podcast, you may recall that at the beginning of this pandemic I made a podcast about tocilizumab and how it does not work. If you go back to that podcast/webpage you actually see that it was the pharmaceutical company, Roche pharmaceuticals,  call based on their own child called a callback the trial they said that should not be used anymore outside of a randomized controlled trials. 

To be continued or you can just listen to the podcast on Tocilizumab from the RECOVERY group. I really haven’t had a chance to finish typing it up. I’ve been quite busy. Thanks for understanding.

REMAP-CAP: Tocilizumab and Sarilumab

REMAP-CAP Investigators, Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, Annane D, Beane A, van Bentum-Puijk W, Berry LR, Bhimani Z, Bonten MJM, Bradbury CA, Brunkhorst FM, Buzgau A, Cheng AC, Detry MA, Duffy EJ, Estcourt LJ, Fitzgerald M, Goossens H, Haniffa R, Higgins AM, Hills TE, Horvat CM, Lamontagne F, Lawler PR, Leavis HL, Linstrum KM, Litton E, Lorenzi E, Marshall JC, Mayr FB, McAuley DF, McGlothlin A, McGuinness SP, McVerry BJ, Montgomery SK, Morpeth SC, Murthy S, Orr K, Parke RL, Parker JC, Patanwala AE, Pettilä V, Rademaker E, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Sligl WI, Turgeon AF, Turner AM, van de Veerdonk FL, Zarychanski R, Green C, Lewis RJ, Angus DC, McArthur CJ, Berry S, Webb SA, Derde LPG. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021 Feb 25. doi: 10.1056/NEJMoa2100433. Epub ahead of print. PMID: 33631065.
Link to Article
Link to FULL FREE PDF

Citation
RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021 May 1;397(10285):1637-1645. doi: 10.1016/S0140-6736(21)00676-0. PMID: 33933206.
Link to Article
Link to FULL FREE PDF

REMAP-CAP Investigators, Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, Annane D, Beane A, van Bentum-Puijk W, Berry LR, Bhimani Z, Bonten MJM, Bradbury CA, Brunkhorst FM, Buzgau A, Cheng AC, Detry MA, Duffy EJ, Estcourt LJ, Fitzgerald M, Goossens H, Haniffa R, Higgins AM, Hills TE, Horvat CM, Lamontagne F, Lawler PR, Leavis HL, Linstrum KM, Litton E, Lorenzi E, Marshall JC, Mayr FB, McAuley DF, McGlothlin A, McGuinness SP, McVerry BJ, Montgomery SK, Morpeth SC, Murthy S, Orr K, Parke RL, Parker JC, Patanwala AE, Pettilä V, Rademaker E, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Sligl WI, Turgeon AF, Turner AM, van de Veerdonk FL, Zarychanski R, Green C, Lewis RJ, Angus DC, McArthur CJ, Berry S, Webb SA, Derde LPG. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021 Feb 25. doi: 10.1056/NEJMoa2100433. Epub ahead of print. PMID: 33631065.
Link to Article
Link to FULL FREE PDF

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