New type of treatment recommended for severe COVID-19

Treating hospitalised COVID-19 patients with drugs that block the effects of an over reactive immune system reduces the risk of death, according to a new study.

Professor Manu Shankar-Hari, a critical care consultant at Guy’s and St Thomas’, was lead author for this research that was co-ordinated by the World Health Organisation (WHO).

The findings have prompted new World Health Organization recommendations to use the treatment in patients with severe or critical COVID-19, along with corticosteroids, which reduce inflammation throughout the body. The body-wide inflammation caused by the immune system is one of the main reasons why COVID-19 is so dangerous.   The study looked at the effect of drugs which block an immune molecule called interleukin-6 (IL-6). The researchers analysed information on almost 11,000 patients who participated in 27 trials of IL-6 blocking treatments from 28 countries. The studies compared the effect of IL-6 blockers to placebo or usual care, including steroid treatments.

Treating patients with IL-6 blockers saved four additional lives for every 100 hospitalised patients. 

One of the areas this study looked at was the effect of combining IL-6 blocking drugs and the existing steroid treatments. It found that the drugs tocilizumab and sarilumab were even more effective when given to patients who were also receiving steroid treatments.

The study included information on 10,930 patients, of whom 6,449 randomly received IL-6 blockers. The other 4,481 received usual care or placebo.

The study showed that hospitalised COVID-19 patients treated with IL-6 blocking drugs had a 22% risk of dying within 28 days. This was a lower risk when compared to 25% for those receiving usual care or a placebo. 

Professor Manu Shankar-Hari, critical care consultant at Guy’s and St Thomas’, Professor of critical care medicine at King’s College London and a NIHR clinician scientist, said: “COVID-19 is a serious illness. Our research shows that interleukin-6 antagonists reduce deaths from COVID-19 and prevent progression to severe illness needing breathing support with a ventilator.

“Interleukin-6 antagonists appear even more effective when used alongside corticosteroids. Our research findings reflect the incredible research effort from scientists worldwide since the start of the pandemic. On a personal note, I am grateful to the patients and their families for their willingness to participate in research during these challenging times.”

Dr Janet Diaz, lead for clinical management, WHO Health Emergencies, said: “Bringing together the results of trials conducted around the world is one of the best ways to find treatments that will help more people survive COVID-19. We have updated our clinical care treatment guidance to reflect this latest development.

“While science has delivered, we must now turn our attention to access. Given the extent of global vaccine inequity, people in the lowest income countries will be the ones most at risk of severe and critical COVID-19. Those are the people these drugs need to reach.”   Claire Vale, principal research fellow at the MRC Clinical Trials Unit at UCL said: “These results, which will lead to better outcomes for patients hospitalized with COVID-19, reflect a huge global effort. Bringing together this information in such a short space of time has only been possible thanks to the overwhelming commitment of all the doctors and teams who ran the trials, and of course, the patients who took part in them.”

The paper was published in the Journal of the American Medical Association.