Life-saving treatments for people with severe Covid-19 are still scarce, bNew results from a major ongoing trial in the UK have revealed an existing one arthritis drug called tocilizumab can noticeably lower the risk of death in hospital patients, especially when combined with steroid treatment.
The RECOVERY trial – led by researchers at the University of Oxford in the United Kingdom – has been testing potential candidates for serious Covid-19 treatment since March 2020, with more than 36,000 participants enrolled. Their findings were some of the first demonstrate that the steroid dexamethasone provided a modest but truly life-saving benefit for hospital patients requiring oxygen support. The study also helped rule out ever-promising treatments like hydroxychloroquine and the HIV cocktail lopinavir ritonavir.
The tocilizumab arm of RECOVERY involved 2,022 patients randomized to receive the drug in addition to standard care, who were then compared to a group of patients of similar size who only received standard care. Soon in this trial, which began in April 2020, steroids became standard treatment; As a result, 82% of the patients were also on steroids drugs too.
According to the results, released Thursday as preprint on MedRxiv, tocilizumab had a modest but clinically significant effect on reducing mortality. In the treatment group, 29% of patients died within 28 days, compared to 33% of patients in the control groupPeople taking tocilizumab were also more likely to be discharged from the hospital within 28 days (54% vs. 47%). In real life-world terms, the drug was expected to save one in 25 patients who took it.
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While some previous studies had found little to no benefit from using tocilizumab, the RECOVERY study is by far the largest study to date to test its effectiveness, the authors noted. W.In combination with steroid treatment, they estimate that these drugs can reduce the risk of mortality by one-third for patients receiving supportive oxygen and half for people on fans.
“Previous studies with tocilizumab had shown mixed results and it was unclear 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 dual impact of dexamethasone plus tocilizumab is impressive and very welcome, ”said Peter Horby, emerging infectious diseases researcher at Oxford and co-principal investigator for RECOVERY, in a statement. pronunciation released by the university.
Tocilizumab is a lab-made monoclonal antibody designed to suppress 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. This can therefore influence the extent to which countries or patients have access to the medicine.
Still, given the ongoing need for reliable options, tocilizumab seems ready to be part of the toolkit for physicians treating these critical cases. And maybe more treatments will come down the line. Another antibody based arthritis drug called sarilumab has shown a similar life-saving promise, 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 US there are still more than 70,000 patients currently in hospital with covid-19.
The RECOVERY researchers are still testing several other drugs, including aspirin and two antibody-based drugs. They also plan to submit their preliminary findings on tocilizumab to a peer-reviewed journal.