An anti-inflammatory arthritis drug called tocilizumab modestly reduces deaths and hospitalizations in patients with severe COVID-19, according to preliminary data from a randomized trial of more than 4,000 patients.
Among hospitalized patients requiring oxygen in the study, there were 596 deaths in the group of 2,022 patients randomly assigned to take tocilizumab — 29 percent died — and 694 deaths in the group of 2,094 patients randomly assigned to standard care — 33 percent died. That’s an absolute difference of 4 percent in mortality and a decrease of 14 percent in the relative death rate.
Tocilizumab was also found to shorten hospital stays, increasing the likelihood that surviving patients could leave the hospital within 28 days of randomization from 47 percent to 54 percent.
Finally, the arthritis drug was also found to help prevent the disease from progressing to the point where patients need mechanical ventilation, reducing mechanical ventilation from 38 percent to 33 percent.
The benefits seen in the trial were in addition to those already seen with the use of dexamethasone, an inexpensive, readily available, easy-to-use steroid drug previously found to reduce deaths in COVID-19 patients. In both patient groups — tocilizumab and standard of care — dexamethasone was given to 82 percent of patients.
The study’s findings — published online but not yet peer-reviewed — suggest that the combination of the two drugs could further reduce the death rate from the devastating pandemic.
Clear and welcome
However, compared to dexamethasone, tocilizumab is not as cheap, readily available or easy to use. The drug is a monoclonal antibody that essentially blocks signaling in the immune system that leads to inflammation. The antibody treatment must be administered intravenously while dexamethasone can be administered orally, by injection or intravenously. And while dexamethasone can cost about $7 for a course, tocilizumab can cost as much as $700.
As such, tocilizumab is unlikely to be a hit anywhere in the fight against COVID-19. But with the scarcity of effective treatments for serious disease, doctors will probably be happy to add it to their arsenal if at all possible.
The data – from the massive RECOVERY trial run in the UK – adds clarity to one of COVID-19’s many murky areas of research. Seven smaller studies have also looked at the use of tocilizumab to treat severe COVID-19 patients in the past. However, the results were mixed and collectively inconclusive. RECOVERY, on the other hand, had data on more than three times as many deaths as all seven studies combined and was able to draw a firm conclusion.
“Previous studies of tocilizumab had mixed results and it was unclear which patients might benefit from the treatment,” emerging infectious disease expert and RECOVERY co-lead Peter Horby said in a press statement. “We now know that the benefits of tocilizumab extend to all COVID patients with low oxygen levels and significant inflammation. The dual impact of dexamethasone plus tocilizumab is impressive and very welcome.”