The drugs reduce inflammation and doctors hope they can help patients recover from the overwhelming immune response that Covid-19 sometimes causes.
The patients were randomly assigned to receive infusions of two rheumatoid arthritis drugs, tocilizumab or sarilumab, or to receive standard care at that time, which includes corticosteroids for most patients.
The international research team found that patients who had rheumatoid arthritis experienced significantly more days when they did not need organ support, compared to those who received standard care.
The data showed that patients who received tocilizumab had a median of 10 days when they needed no organ support, and those who received sarilumab had a median of 11 days. Patients who received no medication had no organ support.
The researchers also found that 27% of the patients who received one of the arthritis remedies died in hospital compared to 36% of those who received standard care.
“We’ve also seen patients recover faster,” he said. “They got better and could be discharged from the ICU faster – and it was average and each patient is slightly different.”
Some serious side effects were reported during the study. Nine were among those who gave tocilizumab, including a bacterial infection, five haemorrhages, two heart events and one person had a debilitating face. Eleven side effects were among those receiving standard care, including four hemorrhages and seven cases of blood clotting. No serious adverse events were reported among those given sarilumab.
Although the new study suggests that treatment with tocilizumab and sarilumab may improve outcomes for critical Covid-19 patients, the researchers noted that some separate studies have previously found no benefit with tocilizumab.
“Many previously reported included less seriously ill patients and excluded patients who had already received respiratory support,” the researchers wrote in the study. “In those trials, no clear evidence suggested that tocilizumab was effective in preventing disease progression, and no benefit in terms of survival was seen.”
‘How to best use it remains unclear’
Among 452 patients randomly assigned to receive a single intravenous administration of tocilizumab or a placebo, the mortality rate 28 days later was 19.7% in the tocilizumab group and 19.4% in the placebo group, according to the summary of the study.
“In this trial of hospitalized patients with severe Covid-19 pneumonia, we found no significant difference in clinical status between the tocilizumab group and the placebo group on day 28. No mortality benefit is associated with the use of tocilizumab, although the trial did not drive for this outcome, ‘wrote researchers at Baylor College of Medicine in Houston and several other institutions around the world.
Tocilizumab is well tolerated, say the researchers and their data suggest that patients may benefit from the drug, although more research is needed to make sure.
The differences between the studies include the severity of patients’ illnesses, the time at which treatment was given and the other types of treatment that patients received, such as corticosteroids, dr. Eric Rubin, editor-in-chief of the New England Journal of Medicine. , and his co-authors Dr. Dan Longo and Dr. Lindsey Baden, wrote in the editorial.
“These points raise thorny issues,” the editorial writers write. “For now, we are sitting with evidence that we can benefit from interleukin-6 inhibitors, at least under some circumstances, but how to best use them remains unclear.”