A new study found that critically ill COVID-19 patients were 45% less likely to die if given a single dose of the rheumatoid arthritis drug tocilizumab (Actemra). The study also found that these patients were more likely to leave the hospital or not need a ventilator one month after treatment, compared with patients who didn’t receive the drug.
These improved outcomes occurred despite these patients having double the risk of developing a second infection.
This research suggests that targeted, timely efforts to reduce a “cytokine storm” that COVID-19 patients experience may be beneficial. This form of immune system overreaction categorized by a runaway inflammation response has been calmed in the past by tocilizumab when used on cancer patients.
The study’s conclusions are based on an examination of the data from 154 critically ill patients treated at Michigan Medicine from early March to late April. The analysis examined patient records through late May.
About half of the patients studied were given tocilizumab and about half didn’t, this being during a time when doctors knew little about what would help ventilated COVID-19 patients. This created the perfect chance to compare the outcomes of the two groups. The study’s authors say clinical trials are still necessary to determine if the drug is beneficial, though.
“One role of epidemiology is to rigorously evaluate real-world data on treatment effects, especially when evidence from clinical trials is not available. We kept trying to prove ourselves wrong as signals of benefit emerged in the data, both because of the immediate implications of these data, and in part because of concern about the supply of the medication for other patients,” said lead study author Emily Somers, “but the difference in mortality despite the increase in secondary infection is quite pronounced, even after accounting for many other factors.”
Senior study author Jason Pogue said he recommends the steroid dexamethasone as the first choice of treatment for critically ill patients with COVID-19, basing the recommendation on more robust data than the recent tocilizumab study contains.
“For a retrospective, single-center study, our data are robust. But at this time, due to the lack of randomized controlled trial data and the much higher cost, we recommend reserving tocilizumab for the treatment of select patients who decompensate while on or after receiving dexamethasone or in patients where the risks of adverse events from steroid therapy outweigh the potential benefits,” Pogue said.
Actemra has been associated with a higher risk of interstitial lung disease, stroke, heart attack, pancreatitis and heart failure.