What are Tocilizumab and Sarilumab treatments for COVID?

[Jm954]

The REMPA-CPAP Clinical trial results show that the drugs reduced the risk of death by 24% for critically ill patients and reduced the time spent in intensive care by up to 10 days. In light of these results, the UK government has said that supplies of tocilizumab are already available in hospitals across the UK and clinicians will be able to treat all those admitted to intensive care units, potentially saving hundreds of lives. They are usually given with dexamethasone, a steroid that dampens the immune response and cytokine storm. Both drugs are normally given to treat rheumatoid arthritis.

This study, published in the Lancet gives details of the results of an observational, non random, single cohort trial of tocilizumab in Italy. 73 (20%) patients in the standard care group died, compared with 13 (7%; p<0·0001) patients treated with tocilizumab (six [7%] treated intravenously and seven [8%] treated subcutaneously). thelancet.com/journals/lanr...

This report in the BMJ shows mixed results in Covid-19: “The results so far on tocilizumab have been mixed, with four randomised controlled trials having reported results, of which two were negative and two were positive. None have reported a mortality benefit at day 28 or 30. The results from Remap-Cap add to this evidence base, and I eagerly look forward to seeing the full results.”

"Critically ill patients treated with the arthritis drug tocilizumab show improved outcomes" bmj.com/content/371/bmj.m4530

The Pharmaceutical Journal reported that "Results from the REMAP-CAP trial have suggested that tocilizumab and sarilumab reduced the risk of death from COVID-19 by 24% when administered in the first 24 hours of a patient entering intensive care. (Note I think there is a typo regarding a date in this paper, it states 2020 and it probably should be 2021). More here:

pharmaceutical-journal.com/...

Things still aren't clear about the best or most effective treatments but progress is being made. Note, as with many covid reports, none of these papers have been peer reviewed.

Jackie

[mrsjsmith]

Thank you Jackie for some positive news,

I believe these are the two treatments that Boris had trouble pronouncing the other evening. I wish they would make the names easier to pronounce or remember 🤔

Colette x

[Ernest2]

Many thanks Jackie.

Just hope they can scale up the Tocilizumab production in timely fashion, and the RA patients don't suffer lack of supply.

Presumably the AZ COVID mAB under development AZD7442 and all its friends, when successful, will hopefully improve much further on the figures. Not sure how far away they might be on those (given the likely acceleration). Following has too much information, but sounds very positive:

pharmaceutical-journal.com/...

Must be a simpler good new write up somewhere.

Best wishes to all,

Ernest

[Big_Dee]

Hello Jm954

I for one am very encouraged by the progress that has been made on treatment of covid. Blessings.

[Smakwater]

Jackie,

These articles have perked my interest, though I have to admit, I will need to read this more than once.

You really do have all the good books.

JM

[bennevisplace]

Thanks Jackie, it's encouraging to read there are more drugs added to the armoury.

The inconsistent results between trials could be due to the MAB being given at a different stage of disease. It seems that REMAP-CAP found the sweet spot.

Most comments mention tocilizumab, but not sarilumab which performed better in the trial, not sure why?

[Jm954 Administrator in reply to bennevisplace]

You’ve hit on my main thoughts. I was thinking of this for BellaBee10 , 9876 and Poodle2 wondering if they should have been offered it. Presumably you need to be an in patient and it’s a fine balance between the immune and cytokine storm suppression. Still lots to learn with this wretched virus.

[bennevisplace in reply to Jm954]

Yes it seems you have to be hospitalised and pretty ill to benefit from these mAbs.