Two drugs used to treat rheumatoid arthritis could help save the lives of one in 12 intensive care patients with true Covid, researchers have found.
The NHS will start using tocilizumab to treat coronavirus patients since Friday, health officials said after results from around 800 patients confirmed the drug provides benefits, which could cut the risk of death by 24 %.
Another arthritis drug, sarilumab, seems to do the same thing, not only saving lives but cutting down on the time patients spend in intensive care.
Early results from a previously proposed international trial of tocilizumab may improve outcomes for those with life-threatening coronavirus infections. However, other experiments reported mixed results.
Both tocilizumab and sarilumab are called IL-6 receptor antagonists, which reduce the effects of proteins that can cause overeating of the immune system. Heavy Covid has previously been linked to dangerous levels of inflammation in the body.
The new findings, which have not yet been peer-reviewed, come from a clinical trial called Remap-Cap (the randomized rooted multifunctional variable platform for community-acquired pneumonia) that introducing more than 3,900 Covid patients in 15 countries worldwide.
The latest study reveals how researchers randomized Covid patients to receive routine care, or an infusion of tocilizumab or sarilumab, within 24 hours of being placed on organ support in intensive care. Fewer patients were given sarilumab since the drug became available longer than tocilizumab.
The researchers then monitored patients’ progress for at least 21 days.
Results from 792 patients across six countries show that tocilizumab and sarilumab reduced the risk of death.
While hospital mortality was 35.8% (142/397) for patients receiving routine care, it was 28.0% (98/350) for tocilizumab and 22.2% (10/45) for sarilumab. Combining the results for the two drugs resulted in a 27.3% (108/395) hospital mortality – an 8.5 percent drop in overall risk of death, or a relative 24% reduction – compared to the group with care normal.
“Treat 12 patients and save one life,” said Dr Anthony Gordon, of Imperial College London, the UK’s lead investigator of the lawsuit behind the findings. “[That’s] great impact. ”
The team also found those given tocilizumab or sarilumab recovered more quickly, leaving intensive care about seven to 10 days earlier than those on routine care.
Dr Lennie Derde, intensive care consultant and European coordinating analyst of the Remap-Cap test, said the international nature of the test was important, given the impact of the global pandemic.
“The results are relevant not just in the UK but across the globe,” she said.
Peter Horby, a professor of emerging infectious diseases and global health at Oxford University, who will lead a Rehabilitation trial to test drugs for the treatment of Covid patients but said the involved in Ramap-Cap, the results said it was good news, noting that so far only the steroids Dexamethasone and hydrocortisone have been found to be life-saving among Covid patients on ventilators. Such drugs also work to suppress inflammation and the immune system.
With about 80% of patients in the Remap-Cap trial also given dexamethasone or another steroid, Horby said tocilizumab and sarilumab appear to provide an additional benefit.
“We have seen an overall reduction in the risk of death in patients with mechanical ventilation of around 12% with dexamethasone [in the Recovery trial], and here you see an overall reduction of about 8% – that would seem to have been the top spot [effect of] dexamethasone, ”said Horby.
But Horby stressed the findings apply only to very severe patients, while tocilizumab and sarilumab are far more expensive than dexamethasone: tocilizumab and sarilumab cost around £ 750 to £ 1,000 each patient, compared with about 5 pounds for dexamethasone.
However, Gordon said the treatments remained cost-effective with the lives they would save and the impact on the time they would spend in intensive care.
“A day in the intensive care unit can cost almost £ 2,000 a day,” he said.
England’s deputy chief medical officer, Professor Jonathan Van-Tam, said: “This is a major step forward in increasing patient survival in intensive care with Covid-19. The data show that tocilizumab, and susceptible sarilumab, accelerates and ameliorates what has gone wrong in intensive care, which is essential for relieving pressure on intensive care and hospitals and to save lives. ”
The Department of Health and Social Care said hospitals already had stores of tocilizumab. “Updated guidance will be issued tomorrow by the government and the NHS to trusts across the UK, encouraging them to use tocilizumab as a treatment for Covid-19 patients admitted to intensive, effective care units. immediately, ”he said.