A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say.
Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care.
The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year.
“We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.”
The trial has recruited more than 2,000 Covid patients in 15 countries to assess the potential benefits of tocilizumab and other immune system-modulating drugs such as sarilumab, anakinra and interferon.
Scientists on the trial released the early results after an analysis of the first 303 patients, who were randomised to receive treatments such as tocilizumab or no immune modulator, found an improvement in those receiving the drug. But the nature of the improvement is far from clear, because scientists have yet to disentangle whether the drug boosted survival rates, shortened time in intensive care, or both.
Previous trials of tocilizumab in coronavirus patients reported mixed results. One major trial of moderately ill Covid patients published last month found the drug made no difference to death rates or the chances of the patients requiring intubation.
Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, said the results needed to be “treated with caution” at this early stage.
“Perhaps combining the data from all the reported trials would suggest there is benefit of taking tocilizumab when severely ill with Covid-19 but it may not be large,” he said. Some critically ill patients die from overwhelming inflammation that is triggered by severe pneumonia caused by the virus, so dampening down the inflammation may help.
“It is possible that different drugs work best at different times during illness with Covid. It seems remdesivir may well work early in the disease process, and not at later stages, while dexamethasone works well at later periods, and not in earlier stages of the disease,” he added.
Dexamethasone, which costs about £5 per dose, was found in trials to cut the risk of death by a third for patients on ventilators. It is now part of standard care for Covid patients in hospital.
Tocilizumab costs between £500 and £1000 depending on whether patients receive one or two doses. “In comparison to dexamethasone, it is more expensive. In comparison to the costs of staying in intensive care, which can come into many thousands of pounds each day, it’s still relatively cheap,” Gordon said.