Arthritis drug Tocilizumab may improve survival in patients with severe COVID-19, Indian study proposes

A tried-and-tested drug used to treat arthritis, an inflammatory condition, also increases the survival outcomes of patients with severe COVID-19, according to a new study in The Lancet. The results from Phase 3 of the "COVID India Tocilizumab (COVINTOC) trial" – the first randomised controlled trial of the drug for COVID-19, done entirely in a lower-middle-income country (LMIC) – are published in The Lancet Respiratory Medicine. The study was authored by a team of 20 researchers led by Dr Arvinder S Soin from Medanta, Dr Rajesh Chawla from Apollo Hospitals and Dr Manoj Goel from Fortis Hospitals in India.Researchers investigated the outcomes of tocilizumab in preventing COVID-19 disease from progressing. Some 180 patients were recruited for the study, from 12 public and private hospitals in India. Of these volunteers, 90 were given tocilizumab and standard care while the remaining 90 received only standard care.In the group treated with tocilizumab, the fraction of patients who observed their disease progressing in 28 days (from moderate to severe, or from severe to death) was 12 percent (11 of 91), compared to 18 percent (16 of 88) of patients given standard care. While this isn't a substantial difference, the study found a more interesting pattern in the subset of patients who had severe COVID-19 disease. In this group, the proportion of patients whose disease progressed to death in 28 days was 16 percent (eight of 50) in the tocilizumab group and 34 percent (14 of 41) in the standard care group.[caption id="attachment_8423541" align="alignnone" width="1280"]

Tocilizumab was found to reduce deaths in patients hospitalised with COVID-19, in the largest drug trial for COVID-19 in the world, the RECOVERY trial. Image. Pixabay[/caption]Patients with severe COVID-19 disease who were given the drug showed lower death rates than those who were given standard care. The study also highlights randomised controlled trials of tocilizumab from around the world, showing conflicting results on hospitalised COVID-19 patients, but also showing potential to decrease the time it takes to discharge someone with COVID-19 and ease the demand on intensive care.The study authors reported that when tocilizumab was consumed, no apparent difference was observed in the deaths or ventilator use in patients with moderate or severe COVID-19 disease. They also point out that the arthritis drug, in an earlier mixed-race and multi-ethnic trial, lowers the progression to ventilator use and death.While there were multiple reasons (not the least of which was the study's small sample size), the study does not make a conclusive argument about the use of tocilizumab for COVID-19. The authors stated that the drug ought to be investigated further."....post-hoc evidence from this study suggests tocilizumab might still be effective in patients with severe COVID-19 and so should be investigated further in future studies," the study authors concluded.Tocilizumab was also among the drugs tested in the world's largest trial of existing drugs against COVID-19 – the RECOVERY trial in the UK. In it, 596 (29 percent) of the 2022 patients in the study were given tocilizumab, and showed that the drug improved the condition of COVID-19 patients who suffered from hypoxia and systemic inflammation."In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the level of respiratory support and were additional to the benefits of systemic corticosteroids," according to the RECOVERY report.