Second breakthrough in major COVID trial
A UK study involving Addenbrooke’s patients has found that a drug used to treat arthritis reduces the chances of severely ill patients dying from Covid-19.
Cambridge University Hospitals NHS Foundation Trust is one of 117 hospitals across the UK participating in the Oxford University led RECOVERY trial. Since March 2020 the study has explored a range of potential treatments to help fight the pandemic.
Latest results show the anti-inflammatory drug tocilizumab reduces the risk of hospitalised patients dying from COVID-19. It also found the drug led to fewer patients being put on a ventilator machine and they were discharged from hospital more quickly. In the UK tocilizumab is approved for the treatment of rheumatoid arthritis.
This is the latest success for the RECOVERY trial. In June 2020 it found the inexpensive and widely available steroid, dexamethasone, reduced death for patients with severe COVID-19 and became part of standard care around the world.
CUH intensive care specialist, Dr Charlotte Summers, commented: “This is a huge step forward for the treatment of patients with COVID-19. Currently there are more hospitalised patients in the UK with COVID-19 than at the peak last year in Spring 2020, so there’s still thousands of patients who will benefit from this breakthrough in the UK and also abroad.”
“I want to thank all those patients and all my colleagues who are assisting with this trial and helping us to achieve some fantastic results within an incredibly short time.
“Like many ICU doctors I have witnessed the devastating consequences of COVID-19, but every breakthrough like this brings more hope that we will control this terrible disease.”
Tocilizumab was added to the trial in April 2020 for COVID patients who required oxygen and had evidence of inflammation. It stopped last month when experts concluded sufficient patients had been enrolled to establish whether the drug helped.
A total of 2022 patients at participating hospitals received tocilizumab by intravenous infusion and were compared with 2094 allocated to usual care alone. 82% of patients were taking a systemic steroid such as dexamethasone.
Treatment with tocilizumab significantly reduced deaths. 596 (29%) of the patients in the tocilizumab group died within 28 days compared with 694 (33%) patients in the usual care group.
This means that for every 25 patients treated with tocilizumab, one additional life is saved.
Tocilizumab also increased the probability of discharge alive within 28 days from 47% to 54% in all patient subgroups, from those requiring oxygen via a simple face mask, to those requiring mechanical ventilators in an intensive care unit.
It also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 3%, although there was no evidence that tocilizumab had any effect on the chance of successful cessation of invasive mechanical ventilation.
The data suggest that in COVID-19 patients with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of a systemic corticosteroid (such as dexamethasone) plus tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation.
Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, University of Oxford, and joint chief investigator for RECOVERY, said “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.”
Martin Landray, professor of medicine and epidemiology at the Nuffield Department of Population Health, University of Oxford, and Joint Chief Investigator, said: "The results from the RECOVERY trial clearly show the benefits of tocilizumab and dexamethasone in tackling the worst consequences of COVID-19 – improving survival, shortening hospital stay, and reducing the need for mechanical ventilators. Used in combination, the impact is substantial.”
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