A clinical trial in the United Kingdom has detected the second treatment capable of saving the lives of covid patients. Those responsible for the Recovery trial have just announced that this drug reduces the mortality of people admitted with serious infections by 4%. The effectiveness may seem reduced, but if this treatment is administered together with dexamethasone – a corticosteroid that reduces inflammation – the mortality of patients is reduced by a third, and 50% in the case of the most severe.
Tocilizumab is a monoclonal antibody approved so far to treat rheumatoid arthritis, a condition characterized by inflammation of the joints. So far the drug had shown unclear results in covid patients.
"The combined impact of dexamethasone and tocilizumab is impressive and very welcome" Peter Horby, University of Oxford
"We now know that this drug helps all patients with low oxygen levels and already suffering from advanced inflammation," explained Peter Horby, an expert in emerging diseases at the University of Oxford. "The combined impact of dexamethasone and tocilizumab is impressive and very welcome," added the doctor in a press release.
The Recovery trial has long sought new treatments for the disease associated with SARS-CoV-2 infection. This branch of the study analyzed the progression of more than 2,000 patients who received the drug, compared with that of many others who received the usual treatment. Mortality was reduced by 4% in absolute terms in the group that received the monoclonal antibody. This means that for every 25 patients treated, a life was saved
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The drug – manufactured by the European pharmaceutical company Roche under the name of Actemra – also increases by 7% the probability of a patient to leave the hospital alive. These effects are also seen both in less severe patients who only require oxygen with a mask and in those who need a mechanical ventilator in the ICU. The combination of this drug with dexamethasone reduces the mortality of patients in the first group by 30% and by almost 50% in those admitted to the ICU.
This new treatment is effective exactly where it is most needed: when it has already The severe phase of covid has begun and patients can fall into an inflammatory spiral produced by their own immune system that can lead to death. The two mentioned drugs are the only ones that have been shown to save lives against covid and they also now show to reduce the length of hospital stay and avoid the need for mechanical respirators.
"The benefit is modest, but given the few therapeutic tools that we have, this is a drug that must be used" Marcos López, president of the Spanish Society of Immunology
Those responsible for the trial have not yet published the full data of this study, but hope to do so in the coming days, as reported by the University of Oxford. A previous trial with this same drug had shown an 8% reduction in mortality in patients already admitted to the ICU.
“Tocilizumab is the most effective monoclonal antibody for now to treat cytokine storms [that uncontrolled production of inflammatory proteins suffered by seriously ill patients] ”, highlights Marcos López Hoyos, president of the Spanish Society of Immunology. "The benefit is modest, but given the few therapeutic tools that we have, this is a drug that must be used in this context," he adds.
Tocilizumab itself does not prevent the cytokine storm. What it does is bind to cells using the same port of entry used by one of the cytokines responsible for severe disease: interleukin 6. This is one of the most abundant inflammatory proteins in critically ill patients. In this way, even if a patient produces a lot of protein, its effect is blocked by the drug. Interleukin cannot bind to cells of the innate immune system, the body's first line of defense against infection , to promote inflammation.
"A reduction in mortality associated with any drug is very good news because we hardly have anything," highlights Jesús Sierra, coordinator of the registry of the Spanish Society of Hospital Pharmacy (SEFH), a database of 16,000 patients to identify drugs associated with a lower mortality from covid
Monoclonal antibodies are the most expensive drugs in the world , but treatment with tocilizumab has a relatively low price, between 850 and 1,200 euros depending on the weight of the patient, Sierra explains. If all seriously ill patients start receiving the drug, each life saved would cost around 28,000 euros.
Dexamethasone , which until today was the only treatment that had been shown to save lives in covid patients, is a very cheap corticosteroid that can be avoided by itself one in eight deaths among the most serious patients and one life in 25 among those who receive oxygen, according to data from the Recovery.
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