Treating critically ill COVID-19 patients with drugs typically used for arthritis may significantly improve survival, a landmark UK study has found. The findings come from a trial which evaluates the effect of treatments on a combination of survival and length of time patients need support in an intensive care unit (ICU).
Patients across the UK who are admitted to ICU are now set to receive the treatments using the drugs tocilizumab and sarilumab, which can reduce the time spent in hospital by up to 10 days, according to the findings of the study which were revealed this week.
“Results from the government-funded REMAP-CAP clinical trial showed tocilizumab and sarilumab reduced the relative risk of death by 24 per cent, when administered to patients within 24 hours of entering intensive care,” the Department of Health and Social Care (DHSC) said.
“Patients receiving these drugs, typically used to treat rheumatoid arthritis, left intensive care between seven to 10 days earlier on average. The rollout of these treatments could therefore contribute significantly towards reducing pressures on hospitals over the coming weeks and months,” it said.
Updated guidance issued on Friday by the government and the National Health Service (NHS) to trusts across the UK, encourage them to use tocilizumab in their treatment of COVID-19 patients who are admitted to intensive care units, effective immediately.
“The 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,” said UK Health Secretary Matt Hancock.
“We have worked quickly to ensure this treatment is available to NHS patients without delay, meaning hundreds of lives will be saved. I am hugely proud of the significant role our NHS and its patients have played in this international trial, and grateful to the outstanding scientists and clinicians behind REMAP-CAP [trial] who have brought this treatment to our patients,” he said.
The UK government said supplies of tocilizumab are already available in hospitals across the UK and clinicians will be able to treat all those admitted to intensive care units, potentially saving hundreds of lives.
The department is working closely with Roche, who manufacture tocilizumab, to ensure treatments continue to be available to UK patients.
“This is a significant step forward for increasing survival of patients in intensive care with COVID-19. The data shows that tocilizumab, and likely sarilumab, speed up and improve the odds of recovery in intensive care, which is crucial for helping to relieve pressure on intensive care and hospitals and saving lives,” said England’s Deputy Chief Medical Officer Professor Jonathan Van-Tam.
Initial findings reported in November 2020 showed that tocilizumab, a drug used to treat arthritis, was likely to improve outcomes among critically ill COVID-19 patients. But the impact on patient survival and length of time on organ support in ICU was not clear at that time.
Now, the latest analysis shows that tocilizumab and a second drug called sarilumab – both types of immune modulators called IL-6 receptor antagonists – have a significant impact on patient survival, reducing mortality by 8.5 per cent.
Furthermore, the treatment also improved recovery so that on average patients were able to be discharged from the ICU about a week earlier.
“This is a significant finding which could have immediate implications for the sickest patients with Covid-19,” said Professor Anthony Gordon, Chair in Anaesthesia and Critical Care at Imperial College London and a Consultant in Intensive Care Medicine at Imperial College Healthcare Trust, involved in the trial.
“We found that among critically ill adult patients – those receiving breathing support in intensive care – treatment with these drugs can improve their chances of survival and recovery. At a time when hospitalisations and deaths from Covid-19 are soaring in the UK, it's crucial we continue to identify effective treatments which can help to turn the tide against this disease,” he said.
Tocilizumab and sarilumab are immunosuppressive drugs used to treat rheumatoid arthritis. They were two of several immune modulation treatments included in the REMAP-CAP trial.
In June last year, the UK government approved dexamethasone as the world's first treatment proven to reduce mortality for COVID-19.
The REMAP-CAP trial found that the rate of death for those in intensive care units on corticosteroids, such as dexamethasone, and respiratory support alone was 35 per cent, which was reduced to 28 per cent when tocilizumab was also administered.
The updated study results show patients receiving tocilizumab and sarilumab were more likely to improve (measured by a combination of reduced time on organ support, such as a ventilator, in the ICU and surviving the hospital admission) compared to patients who received no immune modulator.