Life-saving treatments for people with severe covid-19 are still in short supply, bnew results from a major ongoing trial in the UK found that an existing arthritis, called tocilizumab, can significantly reduce the risk of deaths in the hospital, especially when combined with steroid treatment.
The REPAIR trial – led by researchers at the University of Oxford in the UK – has been testing potential candidates for serious covid-19 treatment since March 2020, with more than 36,000 participants so far. Their findings were among the first to demonstrate that the steroid dexamethasone offers a modest but life-saving benefit to hospital patients in need of oxygen support. The study also helped exclude once promising treatments such as hydroxychloroquine and the HIV cocktail lopinavir-ritonavir.
The tocilizumab arm of RECOVERY involved 2 022 patients who were received in addition to the standard care, which was then compared with a similar group of patients who received only standard care. Shortly after this trial, which began in April 2020, steroids became a standard treatment; As a result, 82% of patients also received steroids drugs too.
According to the results, released Thursday as a preview of MedRxiv, tocilizumab had a modest but clinically significant effect on reducing mortality. In the treatment group, 29% of patients die within 28 days, compared to 33% of patients patients in the control group. People on tocilizumab are also more likely to be discharged from hospital within 28 days (54% versus 47%). In reality-world conditions, the drug would be expected to save one in every 25 patients who took it It.
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Although some previous research has found little or no benefit from the use of tocilizumab, the REPAIR trial is by far the largest single study to date to test its efficacy, the authors said. Wwhen combined with steroid treatment, they estimated that these drugs could reduce the risk of death by one-third for patients with oxygen and with half for people on fans.
‘Previous tests with tocilizumab showed mixed results, and it was unclear which patients would 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, ”said Peter Horby, a researcher in emerging infectious diseases in Oxford and co-principal investigator for REPAIR, in a statement released by the university.
Tocilizumab is a laboratory-produced monoclonal antibody designed to thwart an overactive immune system – a common feature of severe covid-19. Unlike dexamethasone, which also suppresses the immune system, tocilizumab is still patented by the pharmaceutical company Roche and is much more expensive per dose. It can therefore affect how many countries or patients have access to the drug.
In view of the continuing need for reliable options, it appears that tocilizumab is ready to be part of the toolkit for physicians treating these critical cases. And there may be even more treatments. Another antibody-based arthritis remedy called sarilumab showed a similar life-saving promise, while the FDA earlier this week authorized the emergency use of an antibody cocktail developed by Eli Lilly for people at high risk for serious illness and hospitalization. In the US, there are still more than 70,000 patients currently hospitalized with covid-19.
The REPAIR researchers are testing several other drugs, including aspirin and two antibody products. They also plan to present their preliminary findings on tocilizumab to a peer-reviewed journal.