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

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Preliminary results come from the RECOVERY trial, which has been testing potential Covid-19 treatments since March 2020. Tocilizumab was added to the trial in April 2020. The results were shared in a pre-print, but did not not yet been peer reviewed or published in a medical journal.

For the trial, 2,022 patients were randomized to tocilizumab and compared to 2,094 patients who received standard care.

“There were 596 deaths among people in the tocilizumab group, 29%, and there were 694 deaths, 33%, in the usual care group. So that represents a reduction in the risk of death of about a sixth or a seventh, “Martin Landray, professor of medicine and epidemiology in the Nuffield Department of Population Health at the University of Oxford, and investigator in Deputy head of the RECOVERY test, said in a briefing Thursday.

“An absolute difference of four in a hundred,” Landray said. “You have to treat about 25 patients to save a patient, a life.”

Landray said the benefits were consistent across each group of patients studied.

The drug was also found to be beneficial for people who were not on mechanical ventilation at the start of the trial; the risk of progression to mechanical ventilation or of death increases from 38% to 33%.

The benefits of treatment were in addition to those of steroids such as dexamethasone – 82% of patients were given one of these steroids.

“The data suggest that in patients with Covid-19 with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of systemic corticosteroids (such as dexamethasone) and tocilizumab reduces mortality by approximately one one third for patients requiring simple oxygen and almost half for those requiring invasive mechanical ventilation, ”said a press release from the University of Oxford.

“It’s a treatment, just in summary, that reduces mortality, shortens hospital stays and lowers the chances that people will need invasive mechanical ventilators,” Landray said. “It’s good for the patients, it’s good for the health service. And it’s good not only for the health service and the patients here in the UK, but also internationally.”

On February 3, a National Institutes of Health panel released treatment guidelines stating that for ICU patients, “there is not enough data to recommend or not the use of tocilizumab or sarilumab for the treatment of Covid-19 “. Sarilumab is a similar treatment for rheumatoid arthritis. For those who do not require intensive care level care, the panel recommended against using the drugs except in a clinical trial.

Landray noted that most of the earlier trials were smaller and the results were unclear.

“Until these results from RECOVERY, it was not conclusive,” he said, even in other large trials, such as REMAP-CAP. When the results of RECOVERY are added on top of the others, “it becomes completely clear”.

The National Health Service has a large number of patients who were able to contribute to the trials, “this is how you get really clear answers and then you get certainty where there wasn’t before.”

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