Official Title
An Open-label, Randomized, Cross-over Interventional Study to Evaluate the Efficacy and Safety of Tocilizumab Versus Corticosteroids in Hospitalised COVID-19 Patients With High Risk of Progression
Brief Summary

This study aims to compare the efficacy and safety of Methylprednisolone versus Tocilizumab in improving clinical outcomes and reducing the need for ventilator support in COVID-19 patients with moderate COVID-19 disease at risk for complications of cytokine storm. Approximately 310 participants hospitalized with COVID-19 in UMMC, Hospital Sungai Buloh, Hospital Kuala Lumpur and Hospital Tuanku Jaafar will be enrolled into this study. Eligible participants will be selected based on a set of clinical, laboratory and radiological parameters indicative of early stages of CRS and lung function decline prior to being randomized at a ratio of 1:1 to receive either Tocilizumab or Methylprednisolone. Participants will be monitored daily for clinical and laboratory parameters, and at 48 hours, switched to the alternate study arm should they manifest signs and symptoms indicative of decompensation.

Unknown status

Drug: Tocilizumab

IV infusion

Drug: Methylprednisolone

IV infusion

Eligibility Criteria

Inclusion Criteria:

1) Hospitalised symptomatic COVID-19 patients 2( Presence of clinical and radiological
signs of progressive disease, AND laboratory evidence indicative of risk for cytokine storm

All patients participating in this clinical trial must meet the following inclusion

1. Hospitalised symptomatic COVID-19 patients

2. Presence of clinical and radiological signs of progressive disease, AND laboratory
evidence indicative of risk for cytokine storm complications:


Dyspnoea OR RR>20 breaths/min AND O2 sat <93% on RA OR increasing need for O2
supplementation to maintain O2 sat >95% on RA



CXR or CT indicative of pneumonia OR worsening findings over time



CRP levels >60 OR an increase of CRP >20 over 12 hours WITH an increasing ferritin
level OR declining lymphocyte counts

3. Age > 18 years and able to give consent

Exclusion Criteria:

Patients will be excluded if any of the following conditions apply:

1. Known sensitivity/allergy to TCZ or other monoclonal antibodies

2. AST/ALT>5 times UNL, platelet counts <50,000 or neutrophil counts <500

3. Active TB

4. Pregnant

5. Receipt of mechanical ventilation

6. Has received other immunomodulatory drugs (including TCZ) in the past for the
treatment of other conditions

7. Individuals, in the opinion of the investigator, where progression to death is
imminent and inevitable in the next 24 hours irrespective of treatment provision or
who have signed a DNR.

8. Participating in other clinical trials (subject to approval)

9. Any serious medical condition or abnormal clinical laboratory tests which in the
judgement of the investigator may compromise patient safety should he/she participate
in the study.

Eligibility Gender
Eligibility Age
Minimum: 18 Years ~ Maximum: N/A

University Malaya Medical Centre
Kuala Lumpur, Malaysia

Investigator: Reena Rajasuriar, PhD



Adeeba Kamarulzaman, MBBS

Reena Rajasuriar, PhD

University of Malaya
NCT Number
MeSH Terms
Methylprednisolone Acetate
Methylprednisolone Hemisuccinate
Prednisolone acetate
Prednisolone hemisuccinate
Prednisolone phosphate