An anti-inflammatory arthritis drug called tocilizumab modestly reduces deaths and hospitalizations in patients with severe COVID-19, according to preliminary data from a randomized trial of more than 4,000 patients.
Among hospitalized patients who required oxygen in the study, there were 596 deaths in the group of 2,022 patients randomly assigned to use tocilizumab – 29 percent died – and 694 deaths in the group of 2,094 patients randomly assigned to standard of care – 33 percent died. That’s an absolute difference of 4 percent in deaths and a 14 percent drop in the relative mortality rate.
Tocilizumab was also found to shorten hospital stays, increasing the chance that surviving patients could leave the hospital within 28 days of randomization from 47 percent to 54 percent.
Finally, the arthritis drug also seemed to help prevent the disease from progressing to the point where patients need mechanical ventilation, dropping the mechanical ventilation rate from 38 percent to 33 percent.
The benefits seen in the trial were in addition to the benefits already seen with the use of dexamethasone, a low-cost, readily available, easy-to-use steroid drug previously found to reduce the number of deaths in COVID-19 patients . In both patient groups – tocilizumab and standard care groups – dexamethasone was given to 82 percent of the patients.
The study’s findings – published online but not yet peer-reviewed – suggest the combination of the two drugs could further reduce the death rate from the devastating pandemic.
Clear and welcome
However, compared to dexamethasone, tocilizumab is not that cheap, readily available, or easy to use. The drug is a monoclonal antibody that essentially blocks the signaling in the immune system that leads to inflammation. Antibody treatment should be administered intravenously, while dexamethasone can be administered orally, by injection, or intravenously. And while dexamethasone can cost around $ 7 for a course, tocilizumab can cost as much as $ 700.
As such, tocilizumab is unlikely to be a hit anywhere in the fight against COVID-19. Still, given the scarcity of effective treatments for serious diseases, doctors will be happy to add it to their arsenal if possible.
The data – from the UK’s massive RECOVERY trial – adds clarity to one of COVID-19’s many shady areas of research. Seven smaller studies also looked at the use of tocilizumab for the treatment of severe COVID-19 patients in the past. However, the results were mixed and totally inconclusive. In contrast, RECOVERY had data on more than three times as many deaths as all seven studies combined and was able to draw a clear conclusion.
“Previous studies with tocilizumab had shown mixed results and it was unclear which patients could benefit from the treatment,” Peter Horby, emerging infectious disease expert and co-leader of RECOVERY, said in a statement. “We now know that the benefits of tocilizumab apply to all COVID patients with low oxygen levels and significant inflammation. The double impact of dexamethasone plus tocilizumab is impressive and very welcome. “