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RECOVERY trial shows tocilizumab reduces deaths in patients hospitalised with COVID-19

 

The NIHR-supported RECOVERY trial has shown that tocilizumab - an anti-inflammatory rheumatoid arthritis treatment - reduces the risk of death for hospitalised patients with severe COVID-19.

Researchers also found that the drug reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation.

Last year, the RECOVERY study was the world’s first to show that dexamethasone - a cheap and available steroid - reduces the risk of dying from COVID-19. The latest results from the study also suggests that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid - such a dexamethasone - alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation.

RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care.

The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab - beyond those critically ill on mechanical ventilation.

As part of the trial, 2022 patients were randomly allocated to receive tocilizumab by intravenous injection. Results were compared with 2094 patients randomly allocated to usual care alone. 82% of randomised patients were also taking a systemic steroid such as dexamethasone.

The study showed that for every 25 patients treated with tocilizumab, one additional life would be saved. Benefits were seen in all subgroups, including patients requiring oxygen via a simple face mask, in addition to patients in intensive care requiring mechanical ventilators.

For patients who were not on invasive mechanical ventilation when entered into the trial, tocilizumab also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33%.

RECOVERY: NIHR funding and support

The study is jointly funded by the NIHR with UKRI, and sponsored by the University of Oxford.

Delivery of the study is supported by the NIHR Clinical Research Network and the devolved administrations, working alongside the NHS, who together have helped recruit over 35,000 participants at 177 hospital sites across the country.

Professor Nick Lemoine, Medical Director of the NIHR Clinical Research Network said:

“These latest results for tocilizumab are significant and will undoubtedly help save lives - not just in the UK but around the world. They show that tocilizumab - a widely available arthritis treatment - can save lives, shorten hospital stays and decrease the likelihood of requiring mechanical ventilation for hospitalised COVID-19 patients.

“Through our programme of urgent public research - working closely with the RECOVERY team and NHS hospital staff right across the UK - the NIHR has helped over 35,000 patients take part in this flagship treatment study. In doing so, RECOVERY has been able to provide data which has now given the world two life saving treatments against this dreadful disease.”

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.”

Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, and Joint Chief Investigator, 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. We simply would not know this if it wasn’t for the incredible support of NHS patients and staff in the most challenging of circumstances."

Publication of results

The preliminary results will initially be made available via medRxiv and submitted to a peer-reviewed medical journal. For this preliminary report, information on the primary outcome was available for 92% of patients.