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Two arthritis medications prove remarkably effective
The GOOD NEWS from Covid-19 neighborhoods are hard to find these days. A relentless increase in infections is plaguing hospitals around the world. But the results of clinical trials of two drugs announced today only improve the prognosis, both for patients and for hospitals.
The two drugs, called tocilizumab and sarilumab, are currently used to reduce inflammation in patients with arthritis. Hyper-inflammation, where the immune system overdrives and destroys organs, is how covid-19 tends to kill. The search for suitable anti-inflammatory drugs for covid-19 has already revealed one, dexamethasone. It is an inexpensive steroid that suppresses the immune system on all levels. In contrast, tocilizumab and sarilumab are more targeted. They are both made up of antibodies that block the effect of interleukin-6, a protein that stimulates the immune response and has been important in patients with covid-19.
The tocilizumab and sarilumab clinical trial enrolled 800 patients hospitalized with covid-19 who were sick enough to require transfer to intensive care units (ICUs). The trial was carried out in six countries, with most of the participants in Great Britain. (It has an effective covid-19 drug trial program in which a quarter of hospital patients are enrolled.) Half of the 800 patients received one of the two drugs in addition to the standard treatment, and the other half received only the standard treatment (including dexamethasone).
Almost 36% of patients in the standard treatment group died, compared to 27% of patients in the group who also received tocilizumab or sarilumab. In other words, it reduced the death rate by about a quarter. In addition, patients treated with these drugs recovered faster and were discharged from the hospital seven to ten days earlier. Reducing hospital stays would free up many ICU beds – good news in countries like Britain and America, where many hospitals are running out of beds.
The two drugs appear to work equally well, although the results are more certain for tocilizumab which is an older drug and more widely available and which was therefore given to the vast majority of participants in the new treatment arm of the trial.
Medicines are not cheap and can therefore be beyond the means of developing countries. In Britain, intravenous treatment costs £ 750 to £ 1,000 (about $ 1,000 to $ 1,400). The shorter stay in intensive care more than compensates for this amount; a day in the ICU costs around £ 2,000 per patient at the country’s National Health Service (NHS). And, in general, patients who spend fewer days in intensive care recover faster afterwards and need less rehabilitation.
The NHS will immediately start using tocilizumab for patients with covid-19 in ICUs. Hospitals already have supplies of the drug and the government is working with Roche, a drug company that makes it, to increase supplies. For now, Britain has banned exports of tocilizumab and sarilumab. As covid-19-related deaths continue, the trial results bring a ray of hope to patients, exhausted healthcare workers and millions of people in detention.
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