The NHS will start using an arthritis drug to treat hospitalised Covid patients after a breakthrough study found it cuts the risk of dying.
Tocilizumab can reduce swelling inside the organs and, when combined with steroid dexamethasone slashes the odds of death by a third.
Oxford University scientists behind the RECOVERY trial found the drug reduced the risk of death by an extra four per cent, on top of the 20-35 per cent reduction given by dexamethasone.
This means one extra life could be saved for every 25 people given the drug, which is injected into a vein and normally used to treat people with rheumatoid arthritis.
The drug, branded as Actemra or RoActemra, worked for patients reliant on oxygen masks and ventilator who had ‘evidence of inflammation’ in their internal organs.
Professor Peter Horby, an infectious disease expert leading the trial in NHS hospitals, said the results were ‘impressive’. Colleagues claimed the two drugs together had a ‘substantial impact’ on the survival chances of Covid patients.
There are currently still around 26,000 people in hospital with the disease across the UK, with around 2,200 still being admitted each day.
The study’s results — based on data from around 4,000 patients — put to bed some of the earlier research which led to confusion over whether the drug could improve patients’ health and who it could work for.
A study in November claimed that the drug would almost double people’s chances of their symptoms improving within four weeks, but it could not discern whether it improved survival. And a separate study on just 129 people in Brazil, three weeks ago claimed it didn’t work at all and could even increase the risk of death.
Tocilizumab can reduce swelling inside the lungs and, when combined with the steroid dexamethasone, help to reduce the risk of death by a third.
Hospital patients with Covid-19 generally have low oxygen levels in their blood, which can lead to severe organ damage – the RECOVERY trial found patients receiving supplementary oxygen of any kind could benefit from tocilizumab (Pictured: Edward Wilsher, 84, in hospital with coronavirus in Newcastle last month)
‘Previous trials of tocilizumab had shown mixed results, and it was unclear which patients might benefit from the treatment,’ Professor Horby said today.
‘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.’
The NHS is already using the drug experimentally and, now studies have confirmed its effectiveness, it is likely to become part of routine care for Covid patients.
A majority of people admitted to hospital with Covid are now given dexamethasone, which helps to control their immune system and stop it from over-reacting.
And they are given oxygen either through a nasal tube, face mask or, in severe cases, a ventilator tube down their throat.
Covid-19 is deadly because it prevents the lungs from transferring oxygen into the blood, with leads to a condition called hypoxia in which blood oxygen drops so low that it can cause organ failure.
The immune system over-reacting is also a risk for the sickest patients, which causes intense swelling called inflammation that can also be deadly.
Tocilizumab works to control this inflammation by blocking one of the chemicals that causes it, known as interleukin-6.
This is the same purpose it serves in people with rheumatoid arthritis – the main purpose for which it is licensed – who suffer from long-term inflammation in their joints.
WHAT IS TOCILIZUMAB?
The drug tocilizumab is an anti inflammatory, which is currently used to treat rheumatoid arthritis and similar conditions.
It is marketed as Actemra or RoActemra by pharmaceuticals giant, Roche.
In Covid patients it inhibits a specific part of the immune system which occurs when the body goes haywire and attacks itself.
It stops little molecules called interleukin 6 (IL-6) from latching on to their receptors.
Normally, when they bind to the receptors they cause it to die, which leads to significant organ damage.
In Covid patients this happens in the lungs and airways and leads to respiratory issues.
By getting in the way of this pathway the drug allows the body to retain its natural immune response equilibrium and improve a patient’s condition.
The drug is approved for rheumatoid arthritis patients by NICE, Britain’s medicines regulator.
It is given via an injection into the veins, with a single injection lasting around an hour and the dose being big enough to last four weeks at a time.
A typical dose would be a minimum of 480mg, but higher if the patient has a higher body weight at a rate of 8mg per kg.
A 480mg dose would cost £614.40, according to NICE, and would be expected to last for a month for someone who weighs 60kg.
In their study the RECOVERY team gave tocilizumab to 2,022 patients with Covid-19, 82 per cent of whom were also taking dexamethasone.
They compared the findings with 2,094 patients who were receiving only normal hospital care without the trial drug. Many of them were likely also taking dexamethasone.
In the tocilizumab group 596 people died (29%). In the standard treatment group, 694 people died (33%).
Taking the drug also increased the chance of someone being discharged alive within 28 days from 47 per cent to 54 per cent.
The study estimated that, for patients with low blood oxygen, taking both tocilizumab and dexamethasone cut the risk of death by a third if they were using an oxygen mask, or by half if they were on a ventilator.
Professor Landray said: ‘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. This is good news for patients and good news for the health services that care for them in the UK and around the world.’
The study is one of the UK’s biggest breakthroughs for months in the treatment of Covid-19.
The NHS chief executive had alluded to further progress in managing the disease in January when he said he expected coronavirus to become much more treatable in 2021.
Sir Simon Stevens told a Parliamentary health committee meeting last month: ‘I think a lot of us in the health service are increasingly hopeful that the second half of the year and beyond we will also see more therapeutics and more treatments for coronavirus.
‘And I think it is possible that, over the course of the next six to 18 months, coronavirus becomes a much more treatable disease with antivirals and other therapies, which alongside the vaccination programme holds out the hope of a return to a much more normal future.’
On today’s announcement, Professor Stephen Powis, medical director for the NHS, said: ‘Throughout the pandemic where the NHS leads the world has followed, from vaccinating the first patients outside of clinical trials to helping get dexamethasone into frontline care, and now to driving forward research on another breakthrough treatment.
‘I am immensely proud that the NHS is delivering another breakthrough treatment that will significantly increase the chances of survival for Covid patients being treated in England’s hospitals.
‘This is another positive development in our continued fight against the virus and alongside the rollout of the biggest and fastest vaccination programme in our history, with over 10million people receiving protection so far, we can start to look to the future with hope.’
WHAT TREATMENTS ARE THERE FOR COVID AND WHAT IS BEING STUDIED?
The steroid dexamethasone was the first drug to be shown to treat Covid.
Dexamethasone was found to cut the risk of death by a third for patients on ventilators and by a fifth for those on oxygen. But the drug does not work on people with mild illness.
Further data suggests another steroid, hydrocortisone, is just as effective in severely ill patients.
Both calm down an immune overreaction which occurs in some people and causes deadly inflammation.
The anti-inflammatory medicines tocilizumab and sarilumab were also found to reduce the risk of death by about a quarter in ICU patients.
Those drugs appear to only be effective in Covid patients who, despite receiving dexamethasone, is still deteriorating and needs intensive care.
But studies into other promising treatments are still ongoing.
The RECOVERY trial, being run by the University of Oxford, is testing whether gout drug colchicine could reduce the risk of death.
It is an anti-inflammatory, and a separate study by the University of Montreal, revealed just this week that it could cut the chance of being admitted to hospital by up to 25 per cent.
Another drug, called interferon beta, has shown early promise in trials.
Interferon beta is a protein which the body naturally produces when it gets a viral infection. The medicine is used for treating multiple sclerosis.
It’s being given to hospitalised Covid patients in the form of a spray which is inhaled as part of a major trial in Leeds.
Experts hope the drug will stimulate a better immune response in people who struggle to fight off the virus.
Early findings suggest interferon beta can cut the odds of a Covid hospital falling critically ill by almost 80 per cent.
Injecting coronavirus patients with the blood of survivors may also speed up their recovery.
Known as convalescent plasma, the treatment sees antibody-rich blood from former Covid patients injected into vulnerable or elderly people who catch the virus and struggle to fight the infection naturally.
Scientists running a major British trial last month found the therapy had no impact on critically ill patients.
But the REMAP-CAP will continue to test the plasma on people with moderate Covid illness to see if it can halt the infection before their symptoms get worse.