New results confirm the benefit of arthritis drugs in hospitalised patients with COVID-19
07 Jul 2021
Findings published today in the Journal of the American Medical Association (JAMA), have prompted new World Health Organization (WHO) recommendations to use the drugs, tocilizumab or sarilumab, along with corticosteroids, in patients with severe or critical COVID-19.
The new research, which showed that these drugs reduced the risk of dying within 28 days, was based on results from 27 clinical trials conducted worldwide, that included 10,930 hospitalised patients with COVID-19. Importantly, the benefit of giving these drugs were greater in patients who also received corticosteroids, the treatment already recommended by WHO. In such patients, the risk of dying within 28 days was 21% in those receiving either tocilizumab or sarilumab as well as standard steroid treatment, compared with 25% in those who did not receive the new drugs. This means that for every 100 such patients, four more will survive.
There was also a reduction in the risk of mechanical ventilation or death. Among patients also treated with corticosteroids, the risk is 26% in those receiving tocilizumab or sarilumab, compared with around 33% in those who did not receive them. This means that for every 100 such patients, 7 more will survive or avoid mechanical ventilation.
These findings are based on a meta-analysis, conducted by the World Health Organisation Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. This international team comprising doctors who provided results of their trials, and researchers with expertise in clinical trials and meta-analysis, included a team from the MRC Clinical Trials Unit at UCL.
The study also found that these treatments improved other important outcomes. For example, fewer patients needed additional treatments for severe COVID-19 symptoms and more patients were discharged from hospital within 28 days. There was no indication that patients who received tocilizumab or sarilumab were more likely to develop any additional infections or other severe side effects.
In patients with severe COVID-19 infections, the natural immune response goes into overdrive and can cause damage to organs, including the lungs. Tocilizumab and sarilumab, which are usually used to treat arthritis, help to prevent or calm this extreme response and so reduce the associated damage.
Claire Vale, Principal Research Fellow at the MRC Clinical Trials Unit at UCL said: “These results will lead to better outcomes for patients with severe COVID-19. They reflect a global, collaborative effort to bring together a very large amount of information in a very short space of time. This has only been possible thanks to the overwhelming commitment of all the doctors and teams who ran the trials, and of course, the patients who took part in them. I hope that our findings ensure that COVID-19 patients worldwide will benefit from these treatments.”