WASHINGTON POST - Two rheumatoid arthritis drugs that suppress the immune system may help critically ill patients survive covid-19, providing a benefit even on top of the steroids that have been doctors’ main tools in treating the most serious cases of illness, according to a new study.
British regulators cited the new results as they promptly approved the two drugs, tocilizumab and sarilumab, for use in patients in intensive care units. The relative risk of death was reduced by 24 percent when given to people within 24 hours of admission, the data showed.
The results had an unusual path into the public domain. A week before Thanksgiving, one arm of a large clinical trial called REMAP-CAP was halted, through an announcement on Twitter, after a board monitoring patients in the trial had found that the drugs were so effective that it would be unethical to continue giving placebo to critically ill patients.
The clear finding came as a surprise to one of the investigators running the trial, after conflicting evidence on the utility of the drug tocilizumab from other trials. Most of the patients in the trial had already been on steroids, the inexpensive treatment that had shown to be successful at reducing deaths for people who require oxygen.
“We’re currently live in 290 sites around the world, and so there was no way to quietly whisper to 290 sites: ‘Stop randomizing to control in the immune modulation arm, but don’t tell anyone,’ ” said investigator Derek Angus (BCHS ’92), a Pitt Public Health alumnus and chair of critical care medicine at the University of Pittsburgh Medical Center.
“We realized that we had to sort of make one sort of statement, even though damned if you do, damned if you don’t — we totally get people were frustrated,” he said. “We didn’t know all the data, but we did promise we’d get on top of the data as fast as possible.”
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Image: Nurses work with patients in the Intensive Care Unit at St George's Hospital in London on Wednesday, where the number of intensive care beds for the critically sick was increased from 60 to 120, the vast majority of which are for coronavirus patients. (Victoria Jones/PA/AP)