Arthritis drug ‘effective in treating critically ill Covid-19 patients’

A drug used to treat rheumatoid arthritis can improve clinical outcomes of critically ill patients with Covid-19, early results suggest.

Tocilizumab, a medicine that suppresses the immune system and reduces inflammation, has been shown to be effective in treating patients in intensive care units (ICU) with severe Covid-19.

This was when compared with patients who did not receive any immune-modulating drugs, which help to activate, boost or restore normal immune function.

The early findings are yet to be published in a peer-reviewed journal.

This is an absolutely amazing result. To have a second effective therapy for critically ill patients within months of the start of the pandemic is unprecedented

The researchers also said that tocilizumab’s effect on survival, and the length of time patients need to spend in ICU, has not yet been analysed and further data is expected in the coming weeks.

Professor Anthony Gordon, chairman in anaesthesia and critical care at Imperial College London and a consultant in intensive care medicine at Imperial College Healthcare NHS Trust, said: “These early findings show that treatment with this immune modulating drug is effective for critically ill Covid-19 patients in intensive care units.

“When we have the results available from all participants, we hope our findings will offer clear guidance to clinicians for improving the outcomes of the sickest Covid-19 patients.”

Treatment with tocilizumab is thought to cost somewhere between £500 and £1,000 and is administered intravenously.

Results from previous studies on the effect of tocilizumab on Covid-19 patients has been mixed, with some showing benefit while others indicating the drug was not very effective.

The latest findings come from the REMAP-CAP trial, which has recruited more than 2,000 Covid-19 patients in 15 countries to test the effects of tocilizumab and other immune-modulating drugs such as sarilumab, anakinra and interferon.

The analysis led by the team from Imperial College London included data from the first 303 patients randomised to receive treatments such as tocilizumab or no immune modulator.

This most recent evidence for a benefit of tocilizumab comes from preliminary unpublished data and should treated with caution

The researchers said early findings also revealed an antiviral drug, called Kaletra (lopinavir/ritonavir), to be ineffective in treating severe Covid-19 patients, compared with those who did not receive the drug.

They said the results on tocilizumab add to studies from earlier this year which found that Dexamethasone – a steroid treatment – cut the risk of death by a third for patients on ventilators.

Dr Lennie Derde, a consultant in intensive care medicine at the University Medical Centre in Utrecht, said: “This is an absolutely amazing result. To have a second effective therapy for critically ill patients within months of the start of the pandemic is unprecedented.”

But experts warn the results come from unpublished data and should be treated with caution.

Athimalaipet Ramanan, an honorary professor of paediatric rheumatology at the University of Bristol, said it is hard to make any conclusions based on the limited available data.

“Whilst promising, we need see the full manuscript of today’s results to make any firm opinion.

“Tocilizumab may be of benefit to certain patients with Covid-19, the difficulty appears to be in identifying this patient group.”

Derek Hill, professor of medical imaging science at University College London, said: “This most recent evidence for a benefit of tocilizumab comes from preliminary unpublished data and should treated with caution.

“However, if the initial results stand up to full analysis and peer review then it could well be a valuable addition to the armoury of treatments that can help improve outcomes for Covid patients.”

Health and Care Secretary Matt Hancock described the trial results as “fantastic news”, saying: “I’m proud that our NHS was able to play such a significant role in this trial, with so many UK patients in intensive care units benefiting from this remarkable medicine.

“Tocilizumab is an important addition to the armoury of proven therapeutics for Covid-19, which have been discovered thanks to brilliant scientists working with the NHS, supported by the UK Government.

“We will keep working closely with the company to ensure NHS patients can access the medicine now and in the future and await publication of the final results to determine the full benefits to patients.

“The UK has proven time and time again to be at the very forefront of identifying the most promising, innovative treatments for its patients and I want to thank everyone who has played a part in obtaining these hugely promising results.”

Deputy chief medical officer Professor Jonathan Van-Tam said: “These are very promising results, but it’s vital we see the full results once all monitoring of patients is completed. Then we can fully understand the impact this will have for patients in intensive care units around the world.

“It’s evidence of the UK’s excellent life sciences industry advancing global understanding of this disease, both through our own programme of clinical research and through participation in international studies.”