WHO recommends tocilizumab, sarilumab for critically ill covid patients

WHO recommends tocilizumab, sarilumab for critically ill covid patients

Arthritis drugs tocilizumab and sarilumab reduced the risk of death and the need for ventilators among hospitalised Covid-19 patients, finds a new study which appeared in the Journal of the American Medical Association (JAMA).

The study showed that administering one of these drugs in addition to corticosteroids, in hospitalised patients, reduces the risk of death by 17 per cent, compared to the use of corticosteroids alone. This study based on analysis of nearly 11,000 patients has prompted the World Health Organisation (WHO) to recommend the use of these IL-6 inhibitor drugs, in addition to corticosteroids among patients with severe or critical Covid.

In patients not on mechanical ventilation, the risk of mechanical ventilation or death was reduced by 21 per cent, compared to the use of corticosteroids alone, found the study.

Manu Shankar-Hari, a professor at King’s College London and lead author of the paper, said that the research represented a “definitive piece of evidence” in favour of the drugs after earlier studies produced mixed results.

Severely ill Covid patients have an immune system overreaction known as a “cytokine storm” that can cause severe organ damage and death. Tocilizumab and sarilumab are used to treat rheumatoid arthritis, an autoimmune condition, by inhibiting the effects of interleukin (IL)-6, a type of protein called a cytokine that signals the body to mount an inflammatory response. But previous research on whether IL-6 inhibitors can be useful against severe Covid have variously reported benefit, no effect and harm.

This prompted the WHO to coordinate the new study that combined data from 27 randomised trials conducted across 28 countries.The analysis included information on 10,930 patients, of whom 6,449 were randomly assigned to receive interleukin-6 inhibitors and 4,481 to receive usual care or placebo.

Overall, the risk of death within 28 days was 22 percent compared with an assumed risk of 25 percent in those receiving only usual care. Outcomes were better when patients also received corticosteroids, with the risk of dying 21% compared to 25% for those receiving usual care. This means that for every 100 such patients, four more will survive.

Among patients also given corticosteroids, the risk was found to be 26 % for those receiving IL-6 inhibitors compared with an assumed 33 % in those receiving usual care. Tocilizumab and sarilumab, which are given by infusion or injection, are currently recommended for use along with corticosteroids in severe Covid patients in Britain.