A drug used to treat rheumatoid arthritis could help to save the lives of one in 25 patients admitted to hospital with Covid-19 and reduce the need for a mechanical ventilator, scientists have found.
The medicine, known as tocilizumab, was made available for use by the NHS to treat coronavirus patients, after early results last month from another clinical trial showed it significantly reduced the risk of death for intensive care unit patients as well as time spent in hospital by up to 10 days.
Updated guidance will be sent to NHS trusts and clinicians on Monday, recommending that they use the drug for patients admitted to hospital.
In the Recovery trial, researchers found that when given alongside a steroid, known as dexamethasone, tocilizumab reduced the absolute risk of mortality by four percentage points.
The drug was 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 the dexamethasone.
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: “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.”
More than 4,000 patients were involved in the Recovery trial, with 2,022 patients randomly allocated to receive tocilizumab, while the rest received the usual standard care.
A majority (82%) of the patients were taking a steroid such as dexamethasone as part of the standard care.
The researchers found that 596 (29%) of the patients in the tocilizumab group died within 28 days, compared with 694 (33%) patients in the usual care group.
Tocilizumab also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33% among those who were not on invasive ventilation when entered into the trial, the researchers said.
According to the team, the results also suggest that for patients who have significant inflammation and require oxygen, a combination of a steroid such as dexamethasone and tocilizumab cuts deaths by about a third for patients requiring simple oxygen, and nearly a half for those requiring mechanical ventilation.
Treatment with tocilizumab is thought to cost around £500 and is administered intravenously.
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.”
Last year, the Recovery trial found dexamethasone cut the risk of death by a third for patients on ventilators and by a fifth for those on oxygen.
Health and Social Care 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.”
Deputy chief medical officer Professor Jonathan Van-Tam said: “These results present another important advance in our fight against Covid-19 and are good news for patients and clinicians around the world – it’s a combination of both effective therapeutics and vaccines that will mean an end to this pandemic.
“The data published today mean many more patients in hospital with Covid-19 will have access to a proven treatment, speeding up their recovery and reducing the risk of mortality significantly.
“It’s because of the UK’s world-class clinical trials infrastructure, including NIHR infrastructure in NHS hospitals, and the generosity of UK patients to volunteer even though they are ill themselves, that trials like RECOVERY are able to deliver definitive evidence that will save lives, and I am hugely grateful to all those involved.”