Expert comment - Two potentially life-saving drugs for critically ill COVID-19 patients

A trial looking for potential treatments for hospitalised patients with moderate or severe COVID-19 has found that two monoclonal antibody drugs - tocilizumab and sarilumab - could be used to treat critically-ill patients, and add to the benefit already achieved with dexamethasone treatment.
Comment from Prof Stephen Evans: "This is a high-quality trial...It does look as though these drugs give some additional benefit."

The paper is a pre-print, so has not yet been peer-reviewed, but findings suggest these drugs can save one life for every 12 treated. They found these treatments speed up patients' recovery and reduce length of time spent in intensive care by a week for critically-ill patients. Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, commented:

“This is a high-quality trial, and although published as a pre-print is of much higher quality than many non-peer-reviewed papers.

“The trial of these two drugs, which are licensed as (fairly expensive) treatments for arthritis, was based on the possibility that they would have efficacy as suppressing the extreme immune response seen in many patients with COVID-19 who become critically ill.

“Part way through the trial, the RECOVERY trial findings showed that the (cheap) corticosteroid drug dexamethasone had notable mortality benefits.  Consequently, quite a number of the patients in this trial had also received a corticosteroid, either as being in an early trial as well as this one, or by being given them as routine when the RECOVERY results became available.

“It does look as though these drugs give some additional benefit beyond that given by dexamethasone.

“It is encouraging to find good evidence being generated in well conducted randomised trials to show extra treatments that provide benefit for patients in the critical stages of COVID-19 illness.  It must be emphasised that there is no suggestion that these treatments have any role in the early stages of disease."

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