New Delhi: Arthritis drug tocilizumab can reduce the risk of deaths among hospitalised Covid-19 patients, the time spent in hospitals and the chances of requiring ventilator support, a new study has revealed. Tocilizumab is an intravenous drug used to treat rheumatoid arthritis.
The findings, published Thursday, are part of the Randomised Evaluation of COVID-19 Therapy or RECOVERY trial in the UK.
“The data suggests that in Covid-19 patients with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of a systemic corticosteroid (such as dexamethasone) plus tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one half for those requiring invasive mechanical ventilation,” the study noted. It has not been peer-reviewed yet.
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RECOVERY trial
The RECOVERY trial is a national clinical trial in the UK that aims to identify treatments that may be beneficial for people hospitalised with suspected or confirmed Covid-19. It has been testing a range of potential treatment to fight Covid-19 since March 2020 in the UK.
According to the RECOVERY trial website, it is currently testing the following treatments for coronavirus — Colchicine (commonly used as an anti-inflammatory), Regeneron’s antibody cocktail (a combination of monoclonal antibodies directed against coronavirus), Aspirin (commonly used as a blood thinning medicine) and Baricitinib (an immunomodulatory drug used in rheumatoid arthritis).
Previous studies conducted by the RECOVERY trial include the use of convalescent plasma for patients with Covid-19 and hydroxychloroquine (HCQ) on hospitalised coronavirus sufferers.
Last year, on 5 June, the trial concluded that there were no beneficial effects of HCQ on hospitalised patients. On 5 October, it had concluded that drug combination lopinavir-ritonavir is not an effective treatment for Covid-19 hospitalised patients.
On 14 December, the RECOVERY trial on the use of azithromycin, a widely used antibiotic that also reduces inflammation, was concluded.
Earlier this year, on 15 January, RECOVERY trial announced that it stopped recruitment for trials into use of convalescent plasma. The trial has not yet found any convincing evidence of the effect of convalescent plasma on clinical outcomes in hospitalised patients with Covid-19.
In June 2020, the trial found that the inexpensive and widely available steroid dexamethasone reduces death for patients with severe Covid-19. Since then, steroid dexamethasone has been part of standard care for severe patients in the UK. The benefits of tocilizumab, in the present study, were seen in combination with the steroid.
“Previous trials of tocilizumab had shown mixed results, and it was unclear which patients might benefit from the treatment. We now know that the benefits of tocilizumab extend to all Covid-19 patients with low oxygen levels and significant inflammation,” said Peter Horby, professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and joint chief investigator for RECOVERY.
How the study was conducted
The study was conducted on a total of 2,022 patients who were randomly allocated to receive tocilizumab by intravenous infusion and were compared with 2,094 patients who received usual care.
Patients who required oxygen and had evidence of inflammation were recruited for the study between April 2020 and 24 January. The recruitment was stopped only when the researchers decided that sufficient participants had been added to establish the benefits of the study.
The study noted that 82 per cent patients were already taking a systemic steroid such as dexamethasone. “The double impact of dexamethasone plus tocilizumab is impressive and very welcome,” said Horby.
‘Reduces death risks, ventilator support, hospitalisation’
The study revealed that tocilizumab reduced deaths among hospitalised Covid-19 patients. While 596 (29 per cent) patients in the tocilizumab group died within 28 days, 694 (33 per cent) people succumbed to the infection in the usual care group.
The drug’s use also increased the probability of hospital discharge (from 47 per cent to 54 per cent) within 28 days.
“These benefits were seen in all patient subgroups, including those requiring oxygen via a simple face mask through to those requiring mechanical ventilators in an intensive care unit,” the study noted.
“Among patients not on invasive mechanical ventilation when entered into the trial, tocilizumab significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38 per cent to 33 per cent,” the study noted.
The study, however, showed no evidence that tocilizumab had any effect on chances of surviving successful mechanical ventilator support.
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