Arthritis drugs can help critically ill Covid-19 patients, the study suggests

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But experts warn that more research is needed before doctors start using the drugs on a larger scale, because another new study found that a different, similar drug didn’t significantly improve patients hospitalized with Covid-19 pneumonia.

The drugs reduce inflammation, and doctors hope they can help patients recover from the overwhelming immune response that Covid-19 sometimes causes.

The study that showed improvement in patients included data from more than 800 critically ill adults hospitalized with Covid-19 in intensive care units in six countries between March 9 and November 19 in six countries.

Patients were randomly assigned to receive infusions of either two rheumatoid arthritis drugs, tocilizumab or sarilumab, or received standard care at the time, including corticosteroids for most patients.

Rheumatoid arthritis drug reduces risk of death for critically ill Covid-19 hospitalized patients, say researchers

The international team of researchers found that patients who received either rheumatoid arthritis drugs had significantly more days when they did not require organ support compared to those who received standard care.

The data showed that patients who received tocilizumab had a median of 10 days while requiring no organ support, and those who received sarilumab had a median of 11 days. Patients who received neither drug had zero days off organ support.

The researchers also found that 27% of patients who received either arthritis drug died in hospital, compared with 36% of those who received standard care.

“That’s a big change in survival,” Anthony Gordon, a senior researcher in the trial and a professor at Imperial College London in the UK, said earlier of the study at a January briefing.

“We also saw that the patients recovered faster,” he said. “They got better and could be released from IC faster – which was average and every patient is slightly different.”

Rheumatoid arthritis drug falls short as treatment for hospitalized Covid-19 patients in three studies

Some serious side effects were reported during the study. Nine were among those who received tocilizumab, including a bacterial infection, five bleeding, two heart disease, and one person had vision deterioration. Eleven adverse events were among those who received standard of care, including four bleeds and seven blood clotting cases. No serious side effects were reported in those receiving sarilumab.

While the new study suggests that treatment with tocilizumab and sarilumab can improve outcomes for critically Covid-19 patients, the researchers noted that some separate studies previously found no benefit with tocilizumab.

“Many previously reported included less critically ill patients and excluded patients already receiving respiratory support,” the researchers wrote in the study. “In those studies, no clear evidence suggested that tocilizumab was effective in preventing disease progression, and no benefit was seen with regard to survival.”

‘How you can best use them remains unclear’

The other study, published Thursday in the New England Journal of Medicine, found that tocilizumab helped hospital patients with Covid-19 pneumonia get “significantly better” or lower their risk of death.

Among 452 patients randomly assigned to receive either a single intravenous infusion of tocilizumab or a placebo, the death rate 28 days later was 19.7% in the tocilizumab group and 19.4% in the placebo group, according to the summary of the study.

“In this study of hospital patients with severe Covid-19 pneumonia, we found no significant difference in clinical status between the tocilizumab group and the placebo group at Day 28. There was no mortality benefit associated with the use of tocilizumab, although it was powered for this result” wrote the researchers at Baylor College of Medicine in Houston and several other institutions around the world.

Tocilizumab was well tolerated, the researchers say, and their data suggests patients may have benefited from the drug, although more research is needed to know for sure.

An editorial published Thursday alongside the two new studies noted that several factors could explain why one study showed improvement with tocilizumab, which belongs to a class of drugs called interleukin-6 inhibitors, while another study showed no improvement. showed.

Differences between the studies included the severity of the patients’ disease, the time when the treatment was given, and the other types of treatment patients may have received, such as corticosteroids, Dr. Eric Rubin, Editor-in-Chief of the New England Journal of Medicine, and co-authors Dr. Dan Longo and Dr. Lindsey Baden, wrote in the editorial.

“These points raise thorny issues,” write the editorial’s authors. “For now, we are left with evidence of benefit from interleukin 6 inhibitors, at least under certain circumstances, but how best to use them remains unclear.”

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