Clinical trials of two drugs used to reduce inflammation in patients with arthritis announced on Thursday show that reduces death rate of severely sick Covid-19 patients.
The British government on Friday issued new guidance encouraging health care providers to use two arthritis drugs, called tocilizumab and sarilumab, to treat severely sick Covid-19 patients, following the release of promising data that has not yet undergone formal scientific review.
The clinical trial of tocilizumab and sarilumab enrolled 800 patients hospitalised for covid-19 who were ill enough to require transfer to intensive-care units (ICUs). The trial was conducted in six countries, with most of the participants in Britain. (It has an efficient program of covid-19 drug trials, in which a quarter of hospitalised patients are enrolled). Half of the 800 patients received one of the two drugs on top of the standard treatment, and the other half received only the standard treatment (including dexamethasone).
Nearly 36% of patients in the standard-treatment group died, compared with 27% of patients in the group that also received tocilizumab or sarilumab. In other words, it cut the death rate by about a quarter. Moreover, the patients treated with these drugs recovered faster and were discharged from hospital seven to ten days earlier. The reduction in hospital stay would free up lots of ICU beds—welcome news in places like Britain and America, where lots of hospitals are running out of beds.
“I think it’s a huge result,” said Dr. Anthony Gordon, an anesthesiologist and critical care physician at Imperial College London and the trial’s lead researcher. “Showing that drugs that are available and can be used to save lives, in this pandemic, is a wonderful achievement.”
The results raise the profile of these drugs as among the few so far, apart from steroids like dexamethasone, that have reduced Covid deaths in a well-designed clinical trial. (Most of the new study’s participants also took steroids during their hospital stay.)
The big dip in mortality shown in the trial of about 800 patients caught some experts by surprise. Other studies testing the effects of tocilizumab and sarilumab have ended in disappointment, showing little to no benefit in people hospitalized for Covid.
Against the backdrop of other trials, some of which were more rigorously designed than this one, “I guess I would interpret with caution until this was published in a peer-reviewed journal,” said Dr. Lauren Henderson, a rheumatologist at Boston Children’s Hospital who wasn’t involved in the study.
The two drugs, called tocilizumab and sarilumab, are currently used to reduce inflammation in patients with arthritis. Hyper-inflammation, whereby the immune system goes into overdrive and destroys the organs, is how covid-19 tends to kill. The search for suitable anti-inflammatory drugs for covid-19 has already turned up one, dexamethasone. It is a cheap steroid that dampens the immune system across the board. In contrast, tocilizumab and sarilumab are more targeted. They are both made of antibodies that block the effect of interleukin-6, a protein that stokes the immune response and has been prominent in patients with covid-19, The Economist reported.
The drugs are not cheap, and so may be beyond the means of developing countries. In Britain a course of intravenous treatment costs £750-1,000 (about $1,000-1,400). The shorter ICU stay more than offsets this amount; a day at the ICU costs the country’s National Health Service (NHS) around £2,000 per patient. And, in general, patients who spend fewer days in intensive care recover faster afterwards and need less rehabilitation.