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COVID-19: Arthritis drug cuts risk of death in severe coronavirus patients and also time in hospital, study finds

An anti-inflammatory drug usually given for rheumatoid arthritis could help save the lives of one in 25 people admitted to hospital with severe COVID-19.

A Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial using the medicine tocilizumab also found the drug can shorten the time spent in hospital by up to 10 days and reduce the need for a mechanical ventilator.

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The intravenous drug was added to the trial in April 2020 to see if it had any effect on mortality, but investigations at that time gave mixed results.

Researchers found that when given alongside a steroid known as dexamethasone, tocilizumab reduced the absolute risk of mortality by 4%, which means that for every 25 patients treated with the drug, one additional life would be saved.

The drug was also found to reduce the relative risk of death by 14% and cut the time spent in hospital by five days when used for patients on oxygen and in addition to dexamethasone.

Use of the drug increased the probability of discharge from hospital for patients who are severely ill within 28 days from 47% to 54%.

And it also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33%.

The data suggests that in COVID-19 patients with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of the arthritis drug and the steroid reduced mortality by about one third for patients requiring simple oxygen and nearly one half for those requiring invasive mechanical ventilation.

More than 4,000 patients were involved in the trial, with 2,022 patients randomly allocated to receive tocilizumab, while the rest received the usual standard care.

Most (82%) of the patients were receiving a steroid such as dexamethasone during the trial.

Dexamethasone is a corticosteroid used for a wide range of conditions such as rheumatoid arthritis for its anti-inflammatory and immunosuppressant effects.

Prices vary, but tocilizumab costs about £500 per patient and is given by intravenous infusion over an hour or so.

Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, University of Oxford, and joint chief investigator for RECOVERY, said: “Previous trials of tocilizumab had shown mixed results, and it was unclear which patients might benefit from the treatment.

“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.”

Prof Horby said dexamethasone had already saved 12,000 lives in the UK, while tocilizumab could reduce the chance of dying by “about a sixth”.

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Martin Landray, professor of medicine and epidemiology at the Nuffield Department of Population Health, University of Oxford, and joint chief investigator in the trial, said tocilizumab would help mortality, the length of hospital stay and the need for a ventilator “significantly”.

He said: “Every bit we chop off [the total number of deaths] is a big chunk of a solution… if we compare ourselves with where we were in wave one…now we can reduce the risk of death by anything between a third and a half.”

Health Secretary Matt Hancock said: “Today’s excellent news is further proof the UK is at the forefront of the global mission to find safe and effective treatments for this terrible virus.

“I want to thank all those who have played a part in generating these tremendous results – from the British scientists and researchers behind the trial, to the thousands of patients who took part across the country.

“We are working quickly and closely with colleagues across the health system and sector to ensure every NHS patient who needs this treatment should be able to access it – reducing further pressures on the NHS and potentially saving thousands of lives.”

In March 2020, the RECOVERY trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including tocilizumab.

Over 35,000 patients have been enrolled so far from 177 NHS hospitals in the UK.

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