Adding arthritis drug to current COVID treatment further reduces deaths

An anti-inflammatory arthritis drug called tocilizumab slightly reduces deaths and hospital stays in patients with severe COVID-19, according to preliminary data from a randomized trial involving more than 4,000 patients.

Of the inpatients requiring oxygen in the trial, there were 596 deaths in the group of 2,022 patients randomized to take tocilizumab – 29% died – and 694 deaths in the group of 2,094 patients assigned to the trial. hazard to standard care – 33% died. That’s a 4% absolute difference in deaths and a 14% drop in the relative death rate.

Tocilizumab also appeared to shorten hospital stays, increasing the chances that surviving patients will be discharged within 28 days of randomization from 47% to 54%.

Finally, the arthritis medication also appears to help prevent the disease from progressing to the point where patients need mechanical ventilation, dropping the rate of mechanical ventilation from 38% to 33%.

The benefits seen in the trial were in addition to benefits already seen from using dexamethasone, a cheap, readily available and easy-to-use steroid found earlier to reduce deaths in COVID-19 patients. In both patient groups – tocilizumab and standard care groups – dexamethasone was given to 82% of patients.

The results of the trials – published online but not yet peer-reviewed – suggest the combination of the two drugs could further reduce the death rate from the devastating pandemic.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 as cheap, readily available, or easy to use. The drug is a monoclonal antibody that essentially blocks signaling in the immune system that leads to inflammation. Antibody therapy should be given intravenously, while dexamethasone can be given orally, by injection, or intravenously. And while dexamethasone can cost around $ 7 for one course, tocilizumab can cost up to around $ 700.

As such, tocilizumab is unlikely to be a huge hit used everywhere in the fight against COVID-19. Yet, with the scarcity of effective treatments for serious illnesses, doctors will likely be eager to add it to their arsenal when possible.

The data – from RECOVERY’s massive trial in the UK – adds clarity to one of the many obscure areas of COVID-19 research. Seven smaller trials had also looked at the use of tocilizumab to treat patients with severe COVID-19 in the past. However, the results were mixed and collectively inconclusive. RECOVERY, on the other hand, had data on more than three times as many deaths as the seven trials combined and was able to draw a clear conclusion.

“Previous trials with tocilizumab had shown mixed results, and it was not clear which patients might benefit from the treatment,” said Peter Horby, emerging infectious disease expert and co-head of RECOVERY, in a press release. . “We now know that the benefits of tocilizumab extend to all COVID patients with low oxygen levels and severe inflammation. The double effect of dexamethasone and tocilizumab is impressive and very welcome. “