The NIHR-supported RECOVERY trial has shown that tocilizumab – an anti-inflammatory rheumatoid arthritis treatment – reduces the risk of death for hospitalised patients with severe COVID-19.
Researchers also found that the drug reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation.
The RECOVERY trial was the world’s first study to show that dexamethasone – a cheap and available steroid – reduces the risk of dying from COVID-19. The latest results from the study also suggests that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid – such as dexamethasone – alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation.
Not every site involved in the RECOVERY study was asked to deliver the tocilizumab arm. In the South West, the tocilizumab arm was delivered by Torbay and South Devon NHS Trust, Royal Devon and Exeter NHS Foundation Trust and Somerset NHS Foundation Trust. The RECOVERY trial, which involves a number of different treatment arms, is however open at all acute hospitals across the South West Peninsula; Royal Cornwall Hospitals NHS Trust, University Hospitals Plymouth NHS Trust, Royal Devon and Exeter NHS Foundation Trust, Somerset NHS Foundation Trust, Torbay and South Devon NHS Trust, Yeovil District Hospital and Northern Devon Healthcare NHS Trust.
Professor Michael Gibbons, Clinical Director for the Clinical Research Network South West Peninsula (CRN SWP), said: “The recent results from the RECOVERY trial add significant and important information to our knowledge on how best to treat COVID-19. Every single acute hospital in Devon, Cornwall and Somerset is running this study, supported through the CRN. Through the study many of our local patients have had access to tocilizumab and other treatments. The data has now demonstrated the benefit of tocilizumab in improving survival and reducing length of stay for patents with COVID-19 pneumonia and significant inflammation. This is yet another milestone in the ongoing treatment of COVID-19 and our patients have benefitted hugely from these research opportunities. I want to thank all the organisations and staff who worked tirelessly to support the trial and all the patients who participated.”
RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study, also being delivered locally, last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care.
The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab – beyond those critically ill on mechanical ventilation.
As part of the trial, 2022 patients nationally were randomly allocated to receive tocilizumab by intravenous injection. Results were compared with 2094 patients randomly allocated to usual care alone. 82% of randomised patients were also taking a systemic steroid such as dexamethasone.
The study showed that for every 25 patients treated with tocilizumab, one additional life would be saved. Benefits were seen in all subgroups, including patients requiring oxygen via a simple face mask, in addition to patients in intensive care requiring mechanical ventilators.
For patients who were not on invasive mechanical ventilation when entered into the trial, tocilizumab also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33%.
The study is jointly funded by the NIHR with UKRI while delivery of the study is supported by the NIHR Clinical Research Network and the devolved administrations, working alongside the NHS, who together have helped recruit over 35,000 participants at 177 hospital sites across the country.
Professor Nick Lemoine, Medical Director of the NIHR Clinical Research Network, said: “These latest results for tocilizumab are highly significant and will undoubtedly help save lives – not just in the UK but around the world. They show that tocilizumab – a widely available arthritis treatment – can save lives, shorten hospital stays and decrease the likelihood of requiring mechanical ventilation for hospitalised COVID-19 patients.
“Through our programme of urgent public research – working closely with the RECOVERY team and NHS hospital staff right across the UK – the NIHR has helped over 35,000 patients take part in this flagship treatment study. In doing so, RECOVERY has been able to provide data which has now given the world two life saving treatments against this dreadful disease.”