Arthritis drugs added to the growing arsenal of Covid treatments
Starting this week, two new drugs – tocilizumab and sarilumab –will become a standard part of NHS treatment for Covid-19 patients admitted to intensive care.
Results from an encouraging new clinical trial show that the drugs – normally used to treat rheumatoid arthritis – could help to save the lives of one in twelve Covid-19 patients in intensive care.
The two new candidates are the latest in a growing arsenal of Covid-19 treatments.
Tocilizumab and sarilumab
Some critically ill Covid patients die from overwhelming inflammation in the body, caused by the immune system going into overdrive and attacking internal organs instead of the virus. Tocilizumab and sarilumab are both anti-inflammatory drugs which suppress this extreme immune response.
In a recent Remap-Cap clinical trial, the two drugs were given to 792 patients within 24 hours of entering intensive care. Doing so reduced the relative risk of death by 24% compared to those receiving standard care.
Not only did these drugs save lives but they also sped up recovery. On average, patients receiving them left intensive care between seven and ten days earlier than those who did not.
Ivermectin
This “head-lice treatment turned covid cure” is an anti-parasitic drug that’s been around for about 40 years.
In October, Indian Scientists from AIIMS-Bhubaneshwar completed an observational study on ivermectin, concluding it can work as a preventative drug for coronavirus and reduces the risk of transmission.
The Indian Council of Medical Research (ICMR) is yet to include ivermectin in its treatment guidelines. But according to The Economic Times, an Indian newspaper, “doctors have started prescribing it widely, even though there is no concrete evidence about its benefits.”
Other studies on ivermectin are emerging outside India – including randomised controlled trials – and the results are encouraging. An Egyptian study found ivermectin was effective in preventing the development of symptomatic infection in individuals who had come in close contact with family members diagnosed with Covid-19.
The trial’s chief investigator, Waheed Shouman, MD, Professor of Chest Medicine at Zagazig University, urged the WHO to “be open to reviewing the data, rather than exhibiting indifference.”
A well-known, readily available and inexpensive drug like ivermectin, said Shouman, could be a valuable treatment in low-to-middle-income countries.
Dexamethasone
Tocilizumab and sarilumab are not the first anti-inflammatory drugs proven to reduce mortality for Covid-19.
In June last year, the UK government approved dexamethasone, a corticosteroid, as a Covid treatment, following studies that it could cut the risk of death for patients on ventilators by a third.
Tocilizumab and sarilumab won’t serve as replacement drugs but, rather, compliment dexamethasone, which 80% of the patients in the Remap-Cap trial also received.
The big difference is price. While the Dexamethasone costs around £50 for 10 days’ treatment, the cost of treatment for both tocilizumab and sarilumab is anywhere from £750-£1000.
This is a considerable disparity. But Anthony Gordon, professor of anaesthesia and critical care at Imperial College London and chief investigator of the study, believes the drug is still cost-effective given its impact on time spent in intensive care. It’s crucial to bear in mind, he says, that “a day in the intensive care unit can cost close to £2,000.”
Vitamin D
Sales of Vitamin D supplements have soared in recent months and the uses of this age-old substance shouldn’t be overlooked.
Vitamin D helps to regulate the immune system and we know that people with low vitamin D levels can be more susceptible to upper respiratory tract infections.
A number of studies have drawn links between vitamin D deficiency and severe outcomes in Covid-19 patients. Vitamin D can help to prevent an exaggerated inflammatory response, which could explain why a deficiency increases the likelihood of serious illness from the virus.