Covid: Arthritis drug tocilizumab could save one in 25 coronavirus patients, study finds
Video report by ITV News Correspondent Juliet Bremner
Severely ill coronavirus patients in the UK may soon be treated with arthritis drug tocilizumab, after a newly published study shows it can decrease the risk of death.
Following the REMAP-CAP study published in January, the drug was recommended for use in the NHS primarily for patients who were critically ill in ICU. Yet the REMAP-CAP study did not provide information regarding other, less ill patients.
Now, after the RECOVERY trial published today, tocilizumab is set to be recommended for all Covid-19 patients who require oxygen from as early as next week.
What is tocilizumab?
Tocilizumab is a drug typically given to patients suffering from rheumatoid arthritis.
The drug is administered to patients intravenously, as you would do with a bag of saline.
Tocilizumab will likely be used alongside the steroid dexamethasone, which has been used to treat coronavirus patients for several months.
Together, the combination of drugs helps the body's defences against the disease.
How will it help against Covid-19?
Scientists say the drug could save the lives of one in 25 patients admitted to hospital with coronavirus and reduce the need for a mechanical ventilator.
Studies also found it could reduce the time spent in hospital by up to 10 days.
More than 4,000 patients were involved in the Recovery trial, with 2,022 patients randomly allocated to receive tocilizumab, while the rest received the usual standard care.
A majority (82%) of the patients were taking a steroid such as dexamethasone as part of the standard care.
The researchers found that 596 (29%) of the patients in the tocilizumab group died within 28 days, compared with 694 (33%) patients in the usual care group.
Tocilizumab also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33% among those who were not on invasive ventilation when entered into the trial, the researchers said.
According to the team, the results also suggest that for patients who have significant inflammation and require oxygen, a combination of a steroid such as dexamethasone and tocilizumab cuts deaths by about a third for patients requiring simple oxygen, and nearly a half for those requiring mechanical ventilation.
What do the experts say?
Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, University of Oxford, and joint chief investigator for Recovery, said: “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 patients with low oxygen levels and significant inflammation.
“The double impact of dexamethasone plus tocilizumab is impressive and very welcome.”
Last year, the Recovery trial found dexamethasone cut the risk of death by a third for patients on ventilators and by a fifth for those on oxygen.
How much does tocilizumab cost?
Tocilizumab is quite expensive compared to existing Covid-19 treatments.
Each dose of tocilizumab costs around £500. Patients require just one dose of the drug.
However, this is expensive compared to dexamethasone, which costs £5 a dose.
Pharmaceutical firm Roche produces the drug. It remains to be seen whether they can upscale production to help reduce the price.
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What other drugs are being used to treat Covid-19?
Interferon beta is a protein treatment that can be inhaled directly into the lungs has been shown to accelerate recovery and reduce the odds of developing severe Covid-19 in hospital patients.
Results of a UK clinical trial suggest patients who received the drug, known as SNG001, were more than twice as likely to recover from Covid-19, compared with those who received a placebo – a substance designed to have no therapeutic value.
Are there any new treatments on the horizon?
An antibody treatment for coronavirus, used as a passive vaccine to treat Covid-19, has shown positive results according to interim trial results.
Regeneron Pharmaceuticals said there was a reduction in overall infections seen within the first week, with 100% prevention of symptomatic infections.
The company also reported that there were markedly decreased levels and duration of viral shedding in asymptomatic infections that still occurred in a REGEN-COV group trialled in the US.
Phase three results are expected early in the second quarter of this year.
On Tuesday Eli Lilly announced results from the Blaze-1 and Blaze-4 trials looking at the neutralising antibodies bamlanivimab and etesevimab.
The company said data from US clinical trials suggests that together the drugs reduced risk of Covid-19 hospitalisations and death by 70%.
The experimental treatment was given to former US president Donald Trump when he was admitted to the Walter Reed National Military Medical Centre.