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Arthritis drug effective in treating sickest COVID-19 patients

Published: 19 November 2020

Read more about NIHR COVID-19 research

Critically ill patients with COVID-19 treated with an arthritis drug that reduces inflammation are more likely to have improved outcomes, an international study supported by NIHR has found.

The ‘platform trial’ REMAP-CAP trial evaluates the  effect of treatments on a combination of survival and length of time patients need support in an intensive care unit (ICU). 

Seventy-five percent of all study participants have been recruited in the UK through the NIHR’s Clinical Research Network (CRN). 

Early findings from the study show that treatment with tocilizumab, an immunosuppressive drug used to treat rheumatoid arthritis, significantly improves outcomes for critically ill patients with severe COVID-19 and may reduce mortality and time spent in ICU. There is a 99.75% probability that tocilizumab is superior to no immune modulation.

Due to the clinical implications for patients, the researchers have released the findings before they have been peer-reviewed, but are working to analyse and publish them as soon as possible.

The study, based in 15 countries across Europe, involves more than 2,000 COVID-19 patients and is led by Imperial College London and the Intensive Care National Audit & Research Centre (ICNARC) in the UK and Utrecht University in Europe. 

Professor Anthony Gordon, study Chief Investigator, said: “These early findings show that treatment with this immune modulating drug is effective for critically ill COVID-19 patients in intensive care units. When we have the results available from all participants, we hope our findings will offer clear guidance to clinicians for improving the outcomes of the sickest COVID-19 patients.”

The analysis included data from the first 303 patients randomised to receive immune modulation treatments: tocilizumab, sarilumab, anakinra, interferon, or no immune modulator. 

The trial data yielded an estimated odds ratio of 1.87 for a better outcome with tocilizumab compared to no immune modulation, with a high degree of statistical certainty (99.75% probability that tocilizumab is superior to no immune modulation). 

The latest findings come two months after the trial’s earlier results revealed that hydrocortisone steroid treatment improved recovery among critically ill COVID-19 patients.

Dr Lennie Derde, Consultant in Intensive Care Medicine at the University Medical Center in Utrecht and the Immune Modulation Domain Specific Working Group Chair. “This is an absolutely amazing result.

“To have a second effective therapy for critically ill patients within months of the start of the pandemic is unprecedented. Specific targeting of the immune response is theoretically attractive, and now we have shown it works.”

The latest analysis also revealed an antiviral drug called Kaletra (lopinavir/ritonavir) to be ineffective and provided no additional benefit to critically ill COVID-19 patients, compared to those who did not receive the drug.  

More information on the REMAP-CAP study is available on the clinical trial website.

Read more about the REMAP-CAP trial in a case study on the NIHR website.

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