UK researchers have found that two drugs normally used to treat rheumatoid arthritis could help save the lives of one in 12 intensive care patients who are suffering severely from Covid-19. The two drugs, sarilumab and tocilizumab, have been found to not only save lives but also cut the length of time patients spend in intensive care.
With the UK currently enduring its third national lockdown and struggling immensely with the pandemic, the NHS will begin to utilize these two drugs to treat coronavirus patients from this week. Risk of death in these patients with severe cases could potentially be cut by 24% after results from thousands of patients confirmed that the drugs bring benefits.
Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the trial behind the findings, said he expected the drugs to be used in patients in the UK imminently.
“My understanding is they will become available so that we can immediately start treating patients in the intensive care units with these drugs so that they can start having immediate effects,” he said.
“We found that among critically ill adult patients – those receiving breathing support in intensive care – treatment with these drugs can improve their chances of survival and recovery,” Professor Gordon explained.
“At a time when hospitalizations and deaths from COVID-19 are soaring in the UK, it’s crucial we continue to identify effective treatments which can help to turn the tide against this disease.”
Early results from an international trial had previously suggested that tocilizumab may improve outcomes for those suffering from life-threatening coronavirus infections. However, results were mixed from other trials.
Both arthritis drugs are known as IL-6 receptor antagonists, which can lessen the effect of proteins causing an overreaction of the immune system. Those with severe cases of Covid have been linked with dangerous levels of inflammation in the body.
“We saw an absolute reduction in the risk of death in mechanically ventilated patients of about 12% with dexamethasone [in the Recovery trial], and here you are seeing an absolute reduction of about 8% – that would seem to be on top of the [effect of] dexamethasone,” said Peter Horby, professor of emerging infectious diseases and global health at Oxford University.
But Horby was keen to stress that the findings only applied to patients who were critically ill, as well as the fact that tocilizumab and sarilumab are far more expensive than dexamethasone: tocilizumab and sarilumab cost between £750 to £1,000 ($1017 to $1357) per patient, compared with around £5 (just under $7) for dexamethasone.
The new results come from a clinical trial known as Remap-Cap (the randomized embedded multifactorial adaptive platform for community acquired pneumonia), which involves almost 4,000 Covid-19 patients in 15 countries across the world. The results have not yet been peer reviewed but Dr Lennie Derde, intensive care consultant and European coordinating investigator of the Remap-Cap trial, said the fact that the trial was conducted internationally was crucial, given the worldwide impact of the pandemic.
“The results are applicable not just in the UK but across the globe,” she said.
For the study, researchers randomized adult Covid patients within 24 hours of them being put on organ support in intensive care to receive either standard care or an intravenous infusion of tocilizumab or sarilumab. Sarilumab became available for use later than tocilizumab, meaning that fewer patients in the study were given it compared to tocilizumab.
UK Deputy Chief Medical Officer Professor Jonathan Van-Tam said of the breakthrough: “This is a significant step forward for increasing survival of patients in intensive care with COVID-19. The data shows that tocilizumab, and likely sarilumab, speed up and improve the odds of recovery in intensive care, which is crucial for helping to relieve pressure on intensive care and hospitals and saving lives.
“This is evidence of the UK’s excellent research infrastructure and life sciences industry advancing global understanding of this disease, which we have done both through our own programme of clinical research and through our ability to make very large contributions to international studies.”
UK Health Secretary Matt Hancock told the British public: “The UK has proven time and time again it is at the very forefront of identifying and providing the most promising, innovative treatments for its patients.
“Today’s results are yet another landmark development in finding a way out of this pandemic and, when added to the Armory of vaccines and treatments already being rolled out, will play a significant role in defeating this virus.
“We have worked quickly to ensure this treatment is available to NHS patients without delay, meaning hundreds of lives will be saved.
“I am hugely proud of the significant role our NHS and its patients have played in this international trial, and grateful to the outstanding scientists and clinicians behind REMAP-CAP who have brought this treatment to our patients,” he said.