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Covid-19: treatment guidelines: tocilizumab and monoclonal antibodies (updated 23/03/2021)

The Haut Conseil de la santé publique updates the treatment guidelines for the management of Covid-19 with regard to tocilizumab and monoclonal antibodies, after a review and analysis of the literature and international recommendations.

Following this analysis, the HCSP’s recommendations are as follows:

For tocilizumab :

  • not to prescribe tocilizumab outside the framework of randomised clinical trials;
  • not to prescribe tocilizumab in highly immunocompromised patients;
  • to conduct new trials or adapt existing trials to identify target populations for tocilizumab treatment;
  • However, the use of tocilizumab should be considered under the responsibility of the prescriber after collegial discussion of the benefit/risk ratio in the event of aggravation in patients with a persistent hyper-inflammatory state (fever, high CRP, high ferritin) despite standard treatment (SOC) including dexamethasone, in the absence of bacterial or fungal superinfection.

For monoclonal antibodies :

  • to have rapid access to scientific data transmitted to the European and national health authorities (EMA, ANSM), such as the statistical analysis plan, the relevant and significant clinical efficacy data, the MA application file, the safety and tolerance data.
  • not to prescribe bamlanivimab as monotherapy, either as curative treatment or as prophylaxis;
  • to prescribe the monoclonal antibody combinations bamlanivimab/etesevimab or casirivimab/imdevimab with specific activity on SARS-CoV-2 for the treatment of Covid-19 as a priority in the context of randomised clinical trials (Discovery...);
  • to promote studies to better define the target populations;
  • to strictly respect the eligibility criteria in the context of cohort UTAs.

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