Rheumatoid arthritis treatment may improve COVID-19 pneumonia symptoms.
Rheumatoid arthritis drug tocilizumab (brand name Actemra) can reduce the risk for death from pneumonia caused by COVID-19 among hospitalized patients by nearly 40%, according to a new study research letter published in JAMA Internal Medicine. The research team, led by Xavier Mariette, MD, Ph.D., Olivier Hermine, MD, Ph.D., and Pierre-Louis Tharaux, MD, Ph.D., found, “After up to 90 days of hospital care, seven of 63 patients, or 11%, given at least one dose of tocilizumab had died. In comparison, of those who received usual care with other treatments, 11 of 67 had died.”
Based on these findings, tocilizumab, an immunosuppressive drug used to treat moderate to severe rheumatoid arthritis, “is a monoclonal antibody, and laboratory-made protein designed to mimic the immune system’s ability to fight off disease…[it] may help patients with pneumonia caused by COVID-19” researchers said.
“Tocilizumab could be considered in patients hospitalized with moderate to severe pneumonia requiring [oxygen supplementation],” Dr Mariette, head of the rheumatology department at Bicetre Hospital in Paris, said. “It seems that the drug could benefit more patients with high inflammation.”
The World Health Organization (WHO) is currently reviewing several clinical trials of the drug, which have produced mixed results. An Oxford Biomedical Research Center report shared by WHO noted “among patients hospitalized with COVID-19 with hypoxia [and] systemic inflammation: reduces mortality; increases probability of hospital discharge alive within 28 days; reduces probability of progressing to invasive mechanical ventilation or death.”
“Tocilizumab could be considered in patients hospitalized with moderate to severe pneumonia requiring at least 3 L/min of oxygen,” Mariette said. “Definitive conclusion will be given by a meta-analysis of all [randomized trials] that is currently on-going by [the World Health Organization]…The next question will be to compare dexamethasone with or without tocilizumab in the TOCIDEX trial.”
For the JAMA Internal Medicine study, the researchers compared tocilizumab with common methods of treatment for coronavirus symptoms in patients who acquired pneumonia. Previously, the Food and Drug Administration (FDA) had approved the antiviral drug remdesivir, as well as two monoclonal antibodies (bamlanivimab and etesevimab) for mild to moderate COVID-19 cases. The authors reported, “Tocilizumab appears to reduce levels of C-reactive protein, which may be a sign of widespread inflammation, in the blood.”
In February, data from the adaptive trial, referred to as REMAP-CAP, also noted improved patient survival with tocilizumab. However, the authors cautioned that this study, and the recent one, have been the only two of eight randomized trials to find improved 28-day survival with the drug.
“An important limitation of this study is that it [was] set-up in March 2020 and thus very few patients were taking steroids,” Mariette cautioned. “That has now become the standard of care for these patients with moderate to severe pneumonia [so] the next question is to compare steroid treatment with tocilizumab plus steroids.”
In general, the need for effective drug therapies for patients with severe COVID-19 pneumonia continues to be a major challenge for healthcare practitioners.