https://www.washingtonpost.com/health/2021/01/08/covid-arthritis-drugs-treatment/
"Two rheumatoid arthritis drugs that suppress the immune system may help critically ill patients survive covid-19, providing a benefit even on top of the
steroids that have been doctors’ main tools in treating the most serious cases of illness, according to a new study released Thursday before peer review.
British regulators cited the new results as they promptly
approved the two drugs, tocilizumab and sarilumab, for use in patients in intensive care units. The relative risk of death was reduced by 24 percent when given to people within 24 hours of admission, the data showed.
...
The results had an unusual path into the public domain. A week before Thanksgiving, one arm of a large clinical trial called REMAP-CAP was halted, through an announcement on Twitter, after a board monitoring patients in the trial had found that the drugs were so effective that it would be unethical to continue giving placebo to critically ill patients.
The clear finding came as a surprise to one of the investigators running the trial, after conflicting evidence on the utility of the drug tocilizumab from other trials. Most of the patients in the trial had already been on steroids, the inexpensive treatment that had shown to be successful at reducing deaths for people who require oxygen."
...
The data published Thursday showed that patients were given tocilizumab, sarilumab or usual treatment within a day of requiring organ support in the ICU — most typically patients who were on high-flow oxygen or a ventilator. Tocilizumab is manufactured by Roche under the label Actemra, and sarilumab is sold as Kevzara by Sanofi and Regeneron Pharmaceuticals. The drugs, which block certain immune molecules from triggering inflammation, are far more expensive than the cheap steroids already being given to those patients.
The list price of the dose of Kevzara used in the trial is about $3,600. The maximum dose used in the trial of Actemra currently carries a list price of $4,600, but the dose varied by patients’ body weight and could be given either once or twice. Bob Purcell, a spokesman for Genentech, a member of the Roche Group, said that the drug was not approved for use in covid-19 and the pricing might differ if it were approved to treat the illness.
The trial measured the success of the drug by the number of days patients didn’t need organ support, but found that much of the benefit came from preventing death, Angus said.
About 36 percent of patients died in the hospital who received standard care, while 28 percent died on tocilizumab and 22 percent died when given sarilumab. Patients treated with the drugs spent about a week less in the ICU, on average.
Angus said that earlier this week, when the final analysis of the results were ready, there was a discussion about what to do with them.
“We had this extensive conversation Monday night: should we put the results on the preprint server? The National Health Service of the United Kingdom felt like it’s time to give these drugs to patients — we can’t wait for this to go to a journal and peer review,” Angus said.
But he expects physicians in the US may be more conservative, at least waiting for a formal publication — especially given that official treatment guidelines from the
Infectious Diseases Society of America currently recommend against giving tocilizumab to patients.
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