The World Health Organization (WHO) therefore recommended their use on Tuesday, at the same time as corticosteroids, in patients with severe cases of Covid-19, she announced.
Intravenous tocilizumab had shown mixed results in various smaller clinical trials, but this study, published in the scientific journal JAMA, compiles the results of 27 clinical trials in 28 countries. It is the first to cover such a large number of people.
According to its main author, Manu Shankar-Hari, professor at King’s College London, it is a “definitive evidence”.
This analysis focused on the monoclonal antibodies sarilumab and tocilizumab, drugs originally used against rheumatoid arthritis.
They are called interleukin 6 antagonists because they block the receptor for this protein. However, the latter plays a role in the immune overreaction process sometimes triggered by the coronavirus, leading to hyper-inflammation responsible for the most serious cases of Covid-19.
The risk of death decreased
Among hospitalized patients, giving one of these two drugs at the same time as corticosteroids reduced the risk of death by 17%, compared to using corticosteroids alone. Corticosteroids like dexamethasone, which also have an anti-inflammatory effect, were the first treatment to reduce mortality from Covid-19.
In detail, this study studied 10,930 patients, of which 6,449 received treatment (sarilumab or tocilizumab), and 4,481 received usual care or a placebo.
The risk of dying after 28 days among the treatment group was 22%, compared to 25% for the others.
By isolating only people who received treatment and corticosteroids at the same time, the risk of death even dropped to 21%.
In addition, the risk of having to use an artificial respirator was also reduced with treatment.
“Science has done its job, we must now turn our attention to issues of access”, WHO official Janet Diaz said in a statement. “Given the global inequalities for vaccines, people in the poorest countries are the most at risk for severe cases of Covid-19. They are the people these drugs need to reach.”
Tocilizumab is marketed under the name Actemra or RoActemra depending on the markets where it is sold.
A British study, published in February, had already reported encouraging results concerning it. Conducted as part of the large Recovery clinical trial, this study on 4,000 hospitalized patients had shown a reduction in the risk of death and the need for artificial respiration.