A new study breathes life into an all-but-dead approach to treating severe Covid-19
Maybe Roche’s IL-6 drug works for Covid-19 after all.
Actemra, the rheumatoid arthritis drug, was widely used by doctors early in the pandemic on the theory that it could douse the overactive immune response that leads to severe symptoms in many patients. But multiple studies in the spring and summer appeared to find that neither the Roche drug nor a similar antibody from Regeneron and Sanofi had any effect.
In August, BARDA quietly signaled they would stop funding IL-6 blocks for Covid-19. To some, the drugs became a symbol for the need to study molecules in a controlled fashion before pulling them off the shelf in a crisis.
But today, REMAP-CAP, a global trial network that has been testing different Covid-19 drugs in an adaptive fashion at 200 sites on 19 countries, announced that Actemra had worked in their study. A data safety and monitoring board reviewed data from 303 patients and determined Actemra had a 99.75% chance of being better for the sickest Covid-19 patients than giving them no immune modulator at all.
It’s still not clear the degree to which Actemra helped patients in the trial. The trial reached a composite endpoint that combined survival and the length of time, and investigators don’t know yet how the results broke down.
Investigators said they are preparing the data for full release and peer-reviewed publication. The majority of patients in the study were in the UK.
On the recommendation of the data safety and monitoring board, @REMAP_CAP is declaring efficacy of #tocilizumab with an OR of 1.87 for benefit on a combination of survival and length of time patients received organ support in ICU, compared with standard care […]
— remap-cap (@remap_cap) November 19, 2020
If the results hold up, it would make Actemra one of the only drugs to have proven effective in late-stage Covid-19 patients, just as cases and hospitalizations are surging across the globe. The other is dexamethasone, a cheap steroid that has helped reduce the virus’s fatality rate across the globe.
Although US doctors now give blockers for IL-6 and another immune signaling molecule, IL-23, less often, prescriptions continue, according to the most recent available data from Aetion. As of the week of Sept. 14, 1.9% of US patients received some of immune blocker.
While the study gives new life for one repurposed Covid-19 drug, it also dug a nail into the coffin of another. REMAP-CAP announced today that they would stop testing the HIV antiviral cocktail lopinavir/ritonavir after it failed a futility analysis.
The cocktail first failed a trial on severe cases in March, but studies have continued on earlier stage patients. The UK Recovery trial is still testing it.
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