Rheumatoid arthritis is inadequate to treat hospitalized Covid-19 patients in three studies

Tocilizumab, a reused rheumatoid arthritis drug that was once considered a promising treatment for inpatients with Covid-19, is generally considered to be a promising treatment for patients, according to three trials released this week. Did not increase the patient’s recovery or speed up the patient’s recovery.

However, a fourth study found that the drug increased the chances of survival, but the results are considered inconsistent because it was an observational study.

Three of the exams were published in the Journal of the American Medical Association on Tuesday and the other was published in the New England Journal of Medicine on Wednesday.

This makes the photo of tocilizumab use a bit muddy, although studies conducted together show that the drug is not a magic bullet to be used in all inpatients with Covid-19. A group that keeps the door open for use by a particular patient.

“Future results from other randomized trials may help identify specific groups of people who will benefit. However, increasing evidence recommends the use of tocilizumab outside of clinical trials. We support the current guidelines, “Dr. Jonathan Parr told CNN.

Parr, an assistant professor of infectious diseases at the University of North Carolina at Chapel Hill, wrote: editorial It was published with three JAMA studies.

Tocilizumab, sold under the Actemra brand name and used to treat rheumatoid arthritis, blocks the inflammation-causing molecule interleukin-6.

Early in the pandemic, reports from China and Europe showed that by eliminating the uncontrolled inflammation that occurred in response, this drug helped highly ill patients who experienced so-called cytokine storms. Is a coronavirus that has become widely used in the United States.

Research results begin to enter

However, most of these early reports were observational. In other words, instead of specially designing a trial to evaluate tocilizumab, we acquired and analyzed existing data.

But now, the results of trials designed to look at the drug positively are beginning to come in.

the first Of the three JAMA studies, Italian inpatients who had not yet received intensive care and received tocilizumab were found to be less successful than those who received standard treatment. The trial was canceled early because it was “useless”.

A Similar studies In France, we found that tocilizumab may have provided a slight improvement over regular care by day 14, but there was no difference in survival by day 28.

The· Third study Patients in the United States who received tocilizumab within two days of admission to the ICU were found to have an approximately 30% lower risk of in-hospital death than patients who did not receive the drug.

However, because it was an observational study, there may be factors that influence the results, other than how well the drug itself worked.

“We specifically studied tocilizumab administration to highly ill patients who require ICU-level care, in contrast. [other two trials] We studied patients with much less severe severity, “said Dr. Schultigupta of Brigham and Women’s Hospital in Boston, who led the research team.

Dr. David Leaf, the lead author of the study, said: “Within two days of admission to the ICU, we focused on early use of tocilizumab. This may be the key to the effectiveness of tocilizumab — given before irreversible organ damage occurs.” He said in an email.

Gupta said their findings need to be confirmed by large randomized controlled trials.

Fourth studyWe used the gold standard of study design, published in the New England Journal of Medicine on Wednesday-a randomized, double-blind, placebo-controlled study.

We enrolled 243 patients from seven hospitals in the Boston area who were admitted to Covid-19 during the height of the Boston area’s surge.

“The main purpose of this study was to determine whether intravenous tocilizumab at a moderate stage of a patient’s disease could prevent progression to intubation or death,” said the lead research author. Said Dr. John H. Stone, Dean of the Faculty of Clinical Rheumatology. He told CNN by email at Massachusetts General Hospital.

However, the findings did not encourage the use of tocilizumab.

“Our data do not support the notion that early IL-6 receptor blockade is an effective treatment strategy in patients with moderate illness hospitalized for Covid-19 infection,” Stone said. I did.

The results show that the likelihood of intubation or death was similar in both groups, and that patients in both groups took essentially the same amount of time to discontinue oxygenation.

So where does it leave tocilizumab?

“Tocilizumab may still play a role in COVID-19. Some large trials are coming soon and we will elaborate on when and how to use it,” Parr said. “It shouldn’t be completely off the table, but it needs to be more convincing,” he said. Evidence before daily use. “

Stone agreed that the drug could benefit other patient groups, but emphasized the importance of conducting these trials.

“A key point from our trial and the overall experience of IL-6 receptor blockade is that such an approach to the treatment of COVID-19 must be subjected to a randomized, blinded trial. That’s it, “he said. It is done “before it is widely used”.