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Arthritis drug tocilizumab can cut risk of Covid-19 death, finds study involving Addenbrooke’s

A study involving patients at Addenbrooke’s has shown that a drug used to treat rheumatoid arthritis reduces the risk of severely ill Covid-19 patients dying.

It demonstrated that for every 25 patients treated with the anti-inflammatory drug tocilizumab, an additional life is saved.

The drug also led to fewer patients being put on a ventilator machine and sped up their discharge from hospital.

Charlotte Summers, Cambridge University Hospitals’ intensive care specialist
Charlotte Summers, Cambridge University Hospitals’ intensive care specialist

Cambridge University Hospitals NHS Foundation Trust is taking part in the Oxford University-led RECOVERY trial, along with 117 hospitals nationwide, which has explored potential Covid-19 treatments since March 2020.

CUH intensive care specialist Dr Charlotte Summers said: “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 breakthough 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.”

A total of 2,022 patients at participating hospitals were given tocilizumab by intravenous infusion and compared with 2,094 allocated to usual care. Some 82 per cent of patients were taking a systemic steroid such as dexamethasone.

During the trial, which began last April, 596 (29 per cent) of the patients in the tocilizumab group died within 28 days compared with 694 (33 per cent) patients in the usual care group.

Tocilizumab increased the probability of patients being discharged from hospital within 28 days from 47 per cent to 54 per cent in all patient subgroups - from those requiring oxygen via a simple face mask to those requiring mechanical ventilators in an intensive care unit.

And it cut the chance of progressing to invasive mechanical ventilation or death from 38 per cent to 33 per cent. There was no evidence, however, that tocilizumab had any effect on the chance of successful cessation of invasive mechanical ventilation.

It means that for 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 those requiring simple oxygen and by nearly half for those needing invasive mechanical ventilation.

The results represent the second success for the trial, which in June 2020 found that the inexpensive and readily available steroid dexamethasone reduced death for patients with severe Covid-19. That drug is now part of standard care around the world.

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, added: “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.”

The UK’s deputy chief medical officer, Professor Jonathan Van-Tam, said: “These results present another important advance in our fight against Covid-19 and are good news for patients and clinicians around the world - it’s a combination of both effective therapeutics and vaccines that will mean an end to this pandemic.

“The data published today mean many more patients in hospital with Covid-19 will have access to a proven treatment, speeding up their recovery and reducing the risk of mortality significantly.

“It’s because of the UK’s world-class clinical trials infrastructure, including NIHR infrastructure in NHS hospitals, and the generosity of UK patients to volunteer even though they are ill themselves, that trials like RECOVERY are able to deliver definitive evidence that will save lives, and I am hugely grateful to all those involved.”

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