Coronavirus patients in ICU will now receive a now course of treatment on the NHS after a major trial found a single dose of common arthritis drugs reduces the risk of dying from Covid-19 by nearly a quarter.
Anti-inflammatory drugs tocilizumab and sarilumab were part of the REMAP-CAP investigation which involved 3,900 people with severe Covid-19 in 15 countries.
The drugs are administered via an intravenous drip for an hour and given to participants alongside the standard care which includes the steroid dexamethasone.
Dexamethasone was authorised for use on patients in June as clinical study data revealed it reduced the risk of death by 35 per cent.
In the latest study people who only received dexamethasone had a death rate of 35.8 per cent but when given either tocilizumab or sarilumab this dropped to 25.3 per cent.
This 8.5 per cent drop in absolute risk means that around one in four (24 per cent) of people who would otherwise die will be saved by the new treatment, and of all people who will be treated in ICU with the drugs, one in 12 will be saved.
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Anti-inflammatory drugs tocilizumab and sarilumab were part of the REMAP-CAP investigation which involved 3,900 people with severe Covid-19 in 15 countries
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.’
Tocilizumab has been in different clinical trials for a long period of time and interim data from the REMAP-CAP study published in November indicated it was beneficial to the most severely ill patients.
Health and Social Care Secretary Matt Hancock (pictured) said: ‘Today’s results are yet another landmark development in finding a way out of this pandemic and, when added to the armoury of vaccines and treatments already being rolled out, will play a significant role in defeating this virus’
Deputy Chief Medical Officer Professor Jonathan Van-Tam (pictured) said of the breakthrough: ‘This is a significant step forward for increasing survival of patients in intensive care with COVID-19’
The new data, published today as a pre-print, confirms these findings and the Department of Health will, as of tomorrow morning, update its guidance to clinicians and recommend the drugs for use in intensive care.
Both the drugs are commonly found in hospitals and easily administered by trained healthcare workers, and costs up to £1,000 per treatment.
The Department of Health says it is working closely with pharmaceutical giant Roche, who manufacture tocilizumab, to ensure adequate demand. Sarilumab is manufactured by Sanofi and Regeneron.
Health and Social Care Secretary Matt Hancock said: ‘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 armoury 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.’
Dexamethasone is administered daily and costs just £5 but when combined, the likelihood of dying from Covid-19 when in intensive care is now more than a third lower than at the start of the pandemic before either treatment was discovered.
In the study, patients received either tocilizumab or sarilumab, but never both.
Speaking at a press conference today, Professor Anthony Gordon of Imperial College London who is the UK Chief Investigator of the REMAP-CAP trial, said: ‘These results are in exactly the same realm of significance as dexamethasone.
‘Giving these drugs in addition to dexamethasone will save even more lives and are both lifesaving treatments.’
The two rheumatoid arthritis drugs also slash the time a patient spends in ICU as well as reducing the chance of death, with patients treated with either tocilizumab or sarilumab, on average, recovering enough to leave intensive care seven to 10 days ahead of patients just treated with dexamethasone.
‘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,’ explained Professor Gordon.
Coronavirus patients in ICU will now receive a now course of treatment on the NHS after a major trial found a single dose of common arthritis drugs reduces the risk of dying from Covid-19 by nearly a quarter
‘At a time when hospitalisations 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.’
The drugs combat inflammation in the body and the so-called ‘cytokine storm’ the SARS-CoV-2 virus triggers.
This is when the body’s own immune system goes haywire and goes into overdrive, and instead of focusing on destroying the virus, initiates a destructive chain reaction which sees it attack its own healthy and uninfected tissue.
In the majority of cases this is what proves fatal and finding a way to dampen this process is the primary path of research for doctors.
Dexamethasone is a corticosteroid which has a wide-reaching suppression but these two new drugs are more tailored and specific.
They work by latching on to a receptor on human cells which normally binds to a small molecule, made by the immune system, called interleukin 6 (IL-6).
Once this molecule binds it triggers a destructive process and by blocking it from doing so, the signal is dissipated, preventing damage.
‘Steroids dampen inflammation a bit but these two drugs dampen one molecule, interleukin-6, block the receptor in the inflammatory pathway and turn off a lot of the inflammation. They are more specific immunoregulators than dexamethasone,’ Professor Gordon said.
Other ongoing studies are also targeting the IL-6 pathway but have found inhibiting it is ineffective.
Professor Gordon believes the REMAP-CAP study ended up with different findings because of the severely ill nature of the participants.
‘A crucial difference may be that in our study, critically ill patients were enrolled within 24 hours of starting organ support,’ he says.
‘This highlights a potential early window for treatment where the sickest patients may gain the most benefit from immune modulation treatment.’