Life-saving treatments for people with severe covid-19 are still scarce, But new results from a major trial underway in the UK found that an existing An arthritis medication called tocilizumab can noticeably decrease the risk of death for hospitalized patients, especially when combined with steroid treatment.
THE RECOVERY The trial – led by researchers at Oxford University in the UK – has been testing potential candidates for severe covid-19 treatment since March 2020, with over 36,000 participants enrolled to date. His discoveries were some of the first to to demonstrate that the steroid dexamethasone provided a modest but real benefit for patients in hospitals who needed oxygen. The study also helped to rule out previously promising treatments, such as hydroxychloroquine and the HIV cocktail lopinavir-ritonavir.
RECOVERY’s tocilizumab arm involved 2,022 patients randomized to receive the drug in addition to standard treatment, which were then compared to a similarly sized group of patients who received only standard treatment. In this study, which began in April 2020, steroids became the standard treatment; as a result, 82% of patients also received steroids drugs too.
According to the results, released Thursday like a prepress on MedRxiv, tocilizumab had a modest but clinically significant effect in reducing mortality. In the treatment group, 29% of patients died within 28 days, compared with 33% of control group patients. People taking tocilizumab are also more likely to be discharged from the hospital in 28 days (54% vs. 47%). For real-worldwide, the drug is expected to save one in 25 patients who took this.
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While some previous research has found little or no benefit from using tocilizumab, the RECOVERY study is by far the largest single study to date to test its effectiveness, the authors note. ÇWhen combined with steroid treatment, they estimate that these drugs can reduce the risk of mortality by one third for patients using supportive oxygen and half for people on fans.
“Previous studies with tocilizumab have shown mixed results and it was not clear which patients could benefit from the treatment. We now know that the benefits of tocilizumab extend to all COVID patients with low oxygen levels and significant inflammation. The double impact of dexamethasone plus tocilizumab is impressive and very welcome, ”said Peter Horby, a researcher on emerging infectious diseases in Oxford and co-principal investigator at RECOVERY, in a demonstration released by the university.
Tocilizumab is a laboratory-made monoclonal antibody designed to contain an overactive immune system – a common feature of severe covid-19. Unlike dexamethasone, which also suppresses the immune system, tocilizumab is still patented by the pharmaceutical company Roche and is much more expensive per dose. So it can affect how much access countries or patients will have to the drug.
Still, given the continuing need for reliable options, tocilizumab seems destined to be part of the toolkit for doctors who treat these critical cases. And there may still be more treatments in the future. Another antibody-based arthritis medication called sarilumab showed similar promise of saving lives, while the FDA earlier this week authorized the emergency use of an antibody cocktail developed by Eli Lilly for people at high risk of serious illness and hospitalization. In the United States, there are still more than 70,000 patients currently hospitalized with covid-19.
RECOVERY researchers are still testing several other drugs, including aspirin and two antibody-based drugs. They also plan to send their preliminary findings on tocilizumab to a peer-reviewed journal.