Risk of death in critically ill patients is reduced by two anti-inflammatory drugs, according to new results from a global trial involving Southampton researchers.
Two drugs – tocilizumab and sarilumab – have been shown to cut relative risk of death by almost a quarter in adult patients seriously ill with COVID-19.
Critically ill COVID-19 patients treated with the drugs, which are used to treat inflammatory conditions such as rheumatoid arthritis, also left intensive care units (ICUs) up to 10 days earlier.
The research was part of the international REMAP-CAP study, for which Dr Ahilanandan Dushianthan and the critical care research nursing team are recruiting COVID-19 patients admitted to intensive care at University Hospital Southampton.
Adult patients with COVID-19 were recruited within 24 hours of starting organ support in the intensive care unit (ICU). They were then randomly assigned to receive either tocilizumab (8mg/kg), sarilumab (400mg) or standard care (control group).
Both drugs reduced the relative risk of death by 24% over standard care, which saw the majority of patients treated with dexamethasone, one of the few treatments already established to lower mortality in COVID-19 – indicating additive benefits of these latest drugs.
Patients who received the drugs also left intensive care between 7 to 10 days earlier on average, meaning that their use could help reduce pressures on hospitals over the coming weeks and months.
“As a result of this work, most of our enrolled patients had the opportunity to receive multiple potential treatment strategies, including anti-IL 6, which may partly explain the reason for our excellent clinical outcomes,” comments Dr Ahilanandan Dushianthan, ICU consultant in respiratory medicine and Southampton lead for REMAP-CAP.
“It is a privilege to be part of a positive ICU clinical study, particularly during this challenging time. However, we need to be patient until all the results are published in a peer reviewed journal, while results are also expected from the RECOVERY trial.
“This is a testing time for all of us, and I want to thank Kim Golder (REMAP-CAP lead) and the UHS critical care research nursing team, who are an integral part of our clinical team managing critically-ill COVID-19 patients,” he adds.
“Their tireless efforts have seen enrolled 85 patients so far, making us one of the highest recruiting centres in the UK. This is a mammoth achievement for any clinical study, and I can't remember if we have ever managed to enrol this many participants into an ICU clinical trial.”
Reducing dangerous inflammation
An excessive inflammatory response to COVID-19 infection is seen in many critically ill patients, which if left untreated can damage the lungs and other organs.
Interleukin-6 is central to this inflammatory response to infection. Tocilizumab and sarilumab bind to and block the interleukin-6 receptor, dampening down this excessive inflammation.
Previous studies that included less severely affected COVID-19 patients did not show such clear effects, suggesting these drugs are most beneficial for ICU patients seriously ill with COVID-19.