Multiple Sclerosis Awareness Month 2021

Preliminary results from the UK RECOVERY trial released in a preprint last month show that severely ill, hospitalized COVID-19 patients given Tocilizumab in addition to steroids, were less likely to die or require invasive mechanical ventilation.

The RECOVERY trials’ findings indicate that Tocilizumab, an anti-inflammatory monoclonal antibody drug used in treating rheumatoid arthritis, when added to corticosteroid therapy, provides modest mortality benefits for some severely ill COVID-19 patients.

Improved Odds of Survival

The Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial led by researchers at the University of Oxford involved 4,116 severely ill patients. One group received Tocilizumab, while the other received usual care. The majority of participants (82%) also received dexamethasone, a systemic corticosteroid.

Of the 2,022 patients receiving Tocilizumab, 29% (596) died within 28 days after hospitalization versus 33% (694) of the patients receiving usual care. This represents an enhanced survival rate of 4%.

Researchers also found that treatment with the intravenous RA drug also increased patients’ chances (from 47% to 54%) of leaving the hospital alive within 28 days.

Additionally, patients on the Tocilizumab group who were not on a ventilator at the trial’s onset were also less likely to require invasive mechanical ventilation later on. Fewer still went on to need dialysis. However, the drug did not seem to affect rates of successful weaning from mechanical ventilation.

In a press release, RECOVERY researchers wrote:

“The data suggest that in Covid-19 patients with hypoxia (requiring oxygen) and significant inflammation, treatment with the combination of a systemic corticosteroid (such as dexamethasone) plus tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one half for those requiring invasive mechanical ventilation.”

Study of Tocilizumab In COVID-19 Patients

Several other phase-3 clinical trials evaluated the safety and efficacy of Tocilizumab compared to standard care in hospitalized COVID-19 adult patients.

However, these clinical trials were small, and as the authors noted, results were mixed and did not suggest a significant mortality reduction in severely ill, hospitalized COVID-19 patients.

According to Peter Horby, Ph.D., the lead author of the University of Oxford, the findings regarding the benefits of Tocilizumab in conjunction with dexamethasone were, “impressive and very welcome.”

He went on to say:

“Previous trials for Tocilizumab showed 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-19 patients with low oxygen levels and significant inflammation.”

Will Tocilizumab Become A Standard COVID-19 Therapy?

Researchers agree that more data is necessary to understand the full benefits of Tocilizumab in the treatment of severely ill hospitalized COVID-19 patients.

However, based on existing information, the Infectious Disease Society of America guidelines recommend using Tocilizumab in conjunction with standard of care, including steroids in hospitalized adults with progressive severe or critical COVID-19 who display elevated markers of systemic inflammation.

The use of Tocilizumab in tackling the worst consequences of COVID-19, including reducing the need for mechanical ventilators, improving survival, and shortening hospital stay, shows promising results.

As a result of these latest findings, other similar rheumatoid arthritis medications such as Sarilumab are now part of clinical studies, thus proving biologic medications’ versatility.

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