Arthritis drugs found to reduce risk of death in severe Covid-19 cases

The U.K. will start using a Roche Holding AG arthritis drug to treat critically ill Covid-19 patients after a study showed that it reduced mortality and shortened recovery times in intensive care.

Scientists have found that two drugs used to fight arthritis cut the risk of death from Covid-19 by a quarter, in results that will come as relief to health systems around the world which are buckling under the recent rapid spread of the virus.

The immunosuppressants tocilizumab and sarilumab, were found to reduce stays in intensive care by at least seven days on average, according to data released by the UK government-backed Remap-cap study, conducted by researchers at Imperial College London and Utrecht university in the Netherlands. It is one of only a handful of breakthroughs around potential treatments for the virus, and comes at a time when Covid-19 is putting extreme pressure on the healthcare system in large parts of the UK.

These are the first immune-modulating drugs found to have an effect on outcomes of hospitalised Covid-19 patients, adding to positive results from the cheap and plentiful steroid dexamethasone. “Our findings are real and important and we hope they will be able to improve treatments for patients [in hospitals] where numbers are rising rapidly,” said Anthony Gordon, professor of anaesthesia and critical care at Imperial College London and the trial’s UK chief investigator.

[The results] injected that bit of optimism we all need Martin Landray, professor of medicine & epidemiology at Oxford university The researchers gave participants the arthritis drugs on top of steroids and found that they reduced the death rate by 8.5 percentage points, from 35.8 per cent to 27.3 per cent. Furthermore, they added that “patients receiving these drugs . . . left intensive care between seven to 10 days earlier on average”.

Dexamethasone, which costs roughly £50 for a 10-day course of treatment, was found in June to cut the death rate of the most seriously ill patients on ventilators by one-third, and by one-fifth in patients receiving oxygen.  By contrast, courses of tocilizumab and sarilumab cost between £750 and £1,000 per patient. This is still significantly below the average cost of one night’s stay on an intensive care ward, which is about £1,800. The NHS announced that it will on Friday update its guidance, encouraging NHS trusts to use tocilizumab, which is already widely used in the health service, to treat Covid-19 patients who are admitted to intensive care units.

“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,” said Matt Hancock, the health secretary. “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.”

The government said it would work closely with the Swiss pharmaceutical company, Roche, which manufactures tocilizumab, to ensure supplies remained available. Martin Landray, professor of medicine & epidemiology at Oxford university, said the results “injected that bit of optimism we all need”.

The researchers at Imperial believe the outcomes they observed stem from the fact that they looked specifically at severely ill patients and intervened very early during these patients’ deterioration, administering the drugs within 24 hours of them entering intensive care.

Tocilizumab targets single immune signalling molecules called cytokines, and is not commonly used in intensive care settings, unlike common steroids such as dexamethasone. The drugs work by blocking specific receptors in the body that cause inflammation. Findings from the randomised controlled trials, involving 800 patients, have not yet been peer-reviewed.