The potential of a commonly-used arthritis drug in treating seriously-ill Covid-19 patients, especially in avoiding the need for mechanical ventilation, has been confirmed in a UCD School of Medicine study.
The research published in the journal Respirology shows treatment with tocilizumab may deliver a favourable outcome in patients with pneumonia and “hyperinflammatory response” caused by Covid-19 – before they may have to go into an intensive care unit.
Tocilizumab suppresses an over-active immune system and prevents it from attacking the body. It is “a humanised monoclonal antibody” made in a laboratory by identical immune cells that are all clones of a unique parent cell.
The drug is very safe and very well-tolerated when given in cases of inflammatory arthritis but further work is needed to confirm if this is case with coronavirus, the researchers say.
The UCD team have shown it was effective in a subset of Covid-19 patients admitted to St Vincent’s University Hospital in Dublin with severe pneumonia, which in some cases evolves to acute respiratory distress syndrome (ARDS) coupled with hyperinflammatory syndrome.
ARDS is a type of respiratory failure characterised by rapid onset of widespread inflammation in the lungs while hyperinflammatory syndrome is a serious condition in which there is inflammation throughout the whole body – marked by increasing heart rate, low blood pressure, low or high body temperature, and low or high white blood cell count. This condition may lead to multiple organ failure and shock.
A total of 193 patients with confirmed Covid-19 were admitted to SVUH between March 7th and April 7th and enrolled into the All-Ireland Infectious Diseases Cohort Study, a multicentre study led by infectious diseases consultant Prof Paddy Mallon.
Patients were considered for tocilizumab based on presence of severe Covid-19 pneumonia and evidence of a hyperinflammatory response. Six were then treated with a single dose of intravenous tocilizumab.
London study
Lead author Dr Cormac McCarthy, a consultant respiratory physician at SVUH, said “this study suggests treatment with tocilizumab in the pre-ICU setting where patients are critically unwell may avoid the need for mechanical ventilation and may deliver a favourable outcome”.
However, Dr McCarthy stressed the need for caution in interpreting these results due to the small cohort of patients; the group being relatively young, “and the absence of an appropriately matched control group”.
A further trial is in train at SVUH and the Mater Hospital led by Prof Mallon.
Researchers from Imperial College London are also working on tocilizumab's potential to treat Covid-19 by halting the immune system "storm" that the body produces in response to infection. Their trial results on 450 patients around the world is due to be released later this week.
A separate US study at the University of Michigan published last week showed critically-ill Covid-19 patients who received a single dose of tocilizumab were 45 per cent less likely to die and more likely to be discharged from hospital or off a ventilator one month after treatment, compared to those who did not receive the drug.
