Randomized, open, single-center, controlled clinical trial, with 2 treatment arms that seeks to demonstrate the effectiveness of tocilizumab against systemic corticosteroids, both treatments added to supportive treatment in patients admitted for COVID-19 with bilateral pneumonia and poor evolution
Drug: Tociliziumab group
Tocilizumab is a humanized recombinant IgG1 monoclonal antibody to human interleukin-6 (IL-6) receptor, produced in Chinese hamster ovary cells by recombinant DNA technology.
Drug: Methylprednisolone group
Methylprednisolone belongs to a group of medicines called corticosteroids (it works at the cellular level by reducing the production of substances that cause inflammation or allergy).
Inclusion Criteria:
- 1) Patient over 18 years old
- 2) Ability to grant consent
- 3) Bilateral pneumonia produced by SARS-CoV-2 without response in 48-72 hours after
starting the treatment used according to the local protocol. This is defined as
persistence of fever (above 37.5ºC without another focus) and respiratory worsening
(more dyspnea and / or more cough and / or oxygen therapy at increasing doses and / or
worsening of the degree of respiratory distress according to the PaO2 / FiO2 ratio in
categories "mild, moderate or severe") or absence of improvement compared to the
previous state
- 4) Persistently elevated inflammatory markers, among which the following must be met:
ferritin greater than 1000 ng / mL and / or D-dimer greater than 1500 ng / mL and / or
IL-6 greater than 40 pg / mL [35-37], and / or CRP above 150 (mg / L) or having
doubled the CRP provided it was above 50. Since this is what is included within the
definition of "inflammatory phenotype"
Exclusion Criteria:
- 1) Embarazo y lactancia
- 2) Situación terminal o esperanza de vida inferior a 30 días a juicio del investigador
- 3) Alergia o intolerancia a alguno de los fármacos en estudio o a alguno de los
excipientes de los preparados (p. ej polisorbato 80)
- 4) Interacción no tolerable de los fármacos del estudio con alguna medicación crónica
imprescindible del paciente
- 5) Transaminasas elevadas por encima de cinco veces el límite superior de la
normalidad
- 6) Severe neutropenia (<500 cells / mm3)
- 7) Plaquetopenia <50,000 / mm3
- 8) Sepsis (clinical suspicion of active infection at another level with a value on the
qSOFA scale of two or more points) or septic shock (need for vasopressors to maintain
a mean arterial pressure greater than or equal to 65 mmHg, with a lactate of more 2
mmol / L, despite adequate volume replacement
- 9) Another active infection at any level
- 10) Complicated diverticulitis or intestinal perforation
- 11) Renal failure with estimated glomerular filtration rate less than 30 mL / min
- 12) Hepatic failure (Child B onwards)
- 13) Previous use (during the acute process or as chronic medication for another
reason) of medication with a potential effect in this phase of the disease (janus
kinase inhibitors, interleukin 1 inhibitors, other immunosuppressants or
immunomodulators that in the opinion of the investigator could have an effect on the
disease based on pathophysiological criteria or on previous research or started in
this same period). Clarification: The use of dexamethasone according to the RECOVERY
study guideline or corticosteroid therapy at equivalent doses will not be included at
this point.
- 14) Being included in another clinical trial
- 15) Patients who, due to their current situation, their baseline situation or other
aspects, in the opinion of the researcher, are not considered candidates to enter the
study
Clinical Research Platform Biodonostia Health Research Institute
San Sebastián, Guipuzcoa, Spain