Initial data shows arthritis drug is effective in treating sickest Covid-19 patients

19th November 2020

Covid ICU
Critically ill patients with Covid-19 who have been treated with an arthritis drug that reduces inflammation are significantly more likely to have improved outcomes, according to early data from the REMAP-CAP trial.

Led by Professor Anthony Gordon, Consultant in Intensive Care Medicine at Imperial College Healthcare NHS Trust, the research evaluated the effect of the treatment on survival rates and the length of time patients need support in an intensive care unit (ICU). 
The initial data, based on 303 patients, shows that patients receiving tocilizumab, an immunosuppressive drug used to treat rheumatoid arthritis, were more likely to improve when compared to patients who received no immune-boosting drugs. Improvement was measured by looking at a combination of the requirement for organ support, such as a ventilator, in the ICU and surviving the hospital admission.
Due to the clinical implications for patients, the researchers have released the findings before they have been peer-reviewed, but are working to analyse and publish the full results as soon as possible.
Further analysis of the data will explore the impact of the treatment separately on survival and the length of time patients needed ICU support – the current analysis has looked at the impact of the treatment on these measures together. Researchers will also need to further analyse the data to understand the relative benefits of tocilizumab compared to other drugs. Further data are expected in the coming weeks and months.
The REMAP-CAP trial is led by Imperial College London, the Intensive Care National Audit & Research Centre (ICNARC) in the UK and Utrecht University in Europe. REMAP-CAP began investigating treatments for Covid-19 in March 2020, enrolling hospitalised patients with either moderate or severe (requiring ICU care) Covid-19 disease. 
The study design randomises patients to multiple combinations of treatments, enabling researchers to evaluate different treatments for Covid-19, including antivirals, drugs which control the immune response, and therapies that control or support other vital aspects of the body's response to the virus. 
In total, over 2,000 patients in 15 countries have been enrolled at more than 260 hospitals worldwide, including at Imperial College Healthcare, and randomised to multiple treatment combinations. The effects of interventions are assessed separately for moderate and severely ill patients.
Professor Anthony Gordon, who is also Chair in Anaesthesia and Critical Care at Imperial College London said: “These early findings show that treatment with this immune modulating drug is effective for critically ill COVID-19 patients in intensive care units. When we have the results available from all participants, we hope our findings will offer clear guidance to clinicians for improving the outcomes of the sickest COVID-19 patients.”
In addition to these findings, the latest analysis also revealed an antiviral drug called Kaletra (lopinavir/ritonavir) to be ineffective and provided no additional benefit to critically ill Covid-19 patients, compared to those who did not receive the drug. 
The latest findings on tocilizumab and lopinavir/ritonavir add to REMAP-CAP findings from earlier this year, which found that hydrocortisone steroid treatment improved recovery among critically ill COVID-19 patients.
“This is an absolutely amazing result,” said Dr Lennie Derde, Consultant in Intensive Care Medicine at the University Medical Center in Utrecht and the Immune Modulation Domain Specific Working Group Chair. “To have a second effective therapy for critically ill patients within months of the start of the pandemic is unprecedented. Specific targeting of the immune response is theoretically attractive, and now we have shown it works.”
The study is supported in the UK by the National Institute for Health Research (NIHR) and Imperial College London & ICNARC are partners in the EU funded PREPARE consortium.