Tocilizumab is the second to reduce covid patient mortality rate, the world's largest covi drug trial shows

Reporter : Zhu He / http://news.sciencenet.cn/htmlnews/2021/2/453143.shtm / Translation, editing : Gan Yung Chyan, KUCINTA SETIA / Image credit : Roche

 

The results of the world's largest covi drug trial came out: the anti-inflammatory drug Tocilizumab can reduce the risk of death in hospitalized covid patients, reduce the need for ventilators, and shorten their hospitalization period. On 11 February 2021 the British Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial announced the above results, and a preprint of the data has been published on medRxiv.

According to "Science", Athimalaipet Ramanan, a rheumatologist at the University of Bristol in the United Kingdom, said, "This is an incredibly significant result. Ramanan was not involved in this study but she was the director of the Tocilizumab trial in India. She is a Committee member. She said that this may be the second drug to reduce the covid patient death rate after the steroid dexamethasone.

Jason Pogue, a pharmacist at the University of Michigan at Ann Arbor and president of the Institute of Infectious Disease Pharmacists, added in an interview with Science that if the data is reliable, it is "great news."

But the price of tocilizumab is about 100 times that of dexamethasone, which again raises people's questions: how to ensure that the global population can benefit from it.

Tocilizumab is used to treat rheumatoid arthritis and other autoimmune diseases. It is a monoclonal antibody that blocks a protein that acts as a receptor for the immune system's signaling molecule interleukin 6 (IL-6).

Tocilizumab can weaken the immune response, which is often overactive in severely ill covid patients, leading to serious illness and even death.

The journal Science reported that the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial in the United Kingdom is the world's largest COVID-19 drug treatment trial. It has recruited more than 36,000 from more than 170 clinics in the UK. Patients. In addition to identifying two successful drugs, Micedesone and Tocilizumab, it also ruled out several other drugs, including anti-malarial hydroxychloroquine, HIV drugs lopinavir/ritonavir and azithromycin (an antibiotic).

Soon after the pandemic began, doctors began testing the effects of tocilizumab in the treatment of COVID-19 in small clinical trials. Previously, the scientific community was encouraged when a rehabilitation trial in the UK in June 2020 showed that dexamethasone reduced the mortality rate of hospitalized covid patients by as much as one-third. Dexamethasone quickly became part of the standard of care.

Peter Horby, the main researcher of the randomized evaluation trial of covid therapy in the United Kingdom, said at a press conference that day that corticosteroids such as dexamethasone are regarded as roughly the right direction-that is, lowering the human immune system. "We are now looking for highly targeted drugs."

The trial randomly assigned 2022 patients to receive tocilizumab treatment and compared it with 2094 patients randomized to receive routine care. 82% of patients also received dexamethasone.

After 28 days, 596 patients died in the tocilizumab group, compared with 694 patients in the control group. This means that tocilizumab reduced the mortality rate from 33% to 29%.

Compared with dexamethasone, tocilizumab only reduces the effect by 4%, but "absolute reduction of 4% mortality is not trivial," said Ashish Jha, dean of the Brown University School of Public Health. Jha said that the success of dexamethasone may have triggered unrealistic expectations for other drugs. In fact, analysis shows that the advantage of tocilizumab should be greater than that of steroids.

Another scientist involved in the randomized evaluation of COVID-19 therapy, Martin Landray, said at a press conference that the reduction in mortality caused by tocilizumab can benefit all people, whether it is young, old or men. Women, different races... The drug can significantly reduce the probability of covid patients developing to require invasive mechanical ventilation.

Early tocilizumab COVID-19 trials have mixed results, but less than Recovery. Pogue wrote that the recently published results of the randomized, embedded, multi-factor adaptive platform trial (REMAP-CAP) for community-acquired pneumonia convinced some doctors that the drug is beneficial. He wrote: “Given the uneven data from previous clinical trials, others are waiting for recovery.” Although the REMAP-CAP trial included only the most ill patients, the recovery results showed that the benefit also applies to patients with milder conditions. .

However, the price of this drug is much higher than that of dexamethasone. In the UK, each course of treatment is about £500, while the steroid-based dexamethasone is £5. 

Tocilizumab is commercially marketed in the names of Actemra and RoActemra by Roche.