The UK has two new 'life-saving' COVID-19 treatments that cut the death risk by 24% in critically unwell people. Experts say it's not a miracle cure but is 'clearly useful'

By Dr. Catherine Schuster-Bruce

Patients critically unwell with COVID-19 – the disease caused by coronavirus – can be treated with two potentially "life-saving" drugs usually used for rheumatoid arthritis, the UK government announced on Thursday 

Tocilizumab and sarilumab reduced the likelihood of dying from COVID-19 by 24% in those treated with the medicines, compared to those who were not. They also spent 10 days less in hospital, according to a government-funded study — the REMAP-CAP trial — that hasn't been peer-reviewed or published.

The study has received £1.2 million ($1.63 million) of government support, per the UK government.

"The data shows that tocilizumab, and likely sarilumab, speed up and improve the odds of recovery in intensive care, which is crucial for helping to relieve pressure on intensive care and hospitals and saving lives," said the professor Jonathan Van-Tam, the UK's deputy chief medical officer, in a statement in Thursday.

The health secretary, Matt Hancock, said in the statement on Thursday that this was a "landmark development" that will save "hundreds of lives".

NHS clinicians can treat patients in intensive care units with the drugs as soon as Friday, because there are already supplies of tocilizumab in UK hospitals, the UK government said in the statement.

Tocilizumab and sarilumab are both administered as injections into a vein, and given in conjunction with dexamethasone, a steroid treatment that is the usual care for people with COVID-19 that need oxygen. Dexamethasone is the 'breakthrough' treatment, that was proven to reduce the likelihood of dying from COVID-19 in June. 

The treatments are thought to work because they suppress the extra immune response seen in many patients with COVID-19 that become critically unwell, said Stephen Evans, professor of Pharmacoepidemiology at London School of Hygiene & Tropical Medicine, in a statement on Thursday seen by Insider.

Tocilizumab and sarilumab cost more than dexamethasone, with an NHS indicative drug cost of about £912 for each pre-filled injection, according to the British National Formulary. Dexamethasone is roughly £20 per vial.

Martin Landray, professor of Medicine & Epidemiology at the University of Oxford, said that the REMAP-CAP trial results are good news but that there are unanswered questions. 

It is not known whether these treatments work in people who have early stage disease on hospital wards, or in the community.  Studies like the RECOVERY trial are ongoing to find out whether they might be used to prevent people from requiring ventilators, for example.

"Exactly how well does tocilizumab work in different types of patients?" Landray said in a statement on Thursday seen by Insider. 

The REMAP-CAP study has not been peer-reviewed, which means the author's number-crunching has not been scrutinized by experts.

Professor Evans said that the trial was "high quality."

Dr Adam Jacobs, director of biostatistics at Premier Research said in a statement seen by Insider on Thursday that the complex methods needed peer review. The researchers measure the drug's success using a score that combines "mortality" and "number of days without organ support", for example. Jacobs said that these are not comparable. 

"Mortality is clearly far more important than one extra day of organ support," he said.

There was also only a small number of patients treated with sarilumab, said Jacobs. This means there's a certain risk that the results suggesting sarilumab treatment is better than not giving it, could be due to chance. Jacobs said that tocilizumab was given to more patients and appears to work, however.

"There is an 8% absolute risk difference between tocilizumab and the control treatment.  That means that if you gave it to 100 people in intensive care with COVID-19 infection, then you would expect eight more of them to survive than would have done otherwise," he said.

"The magnitude of the effect for tocilizumab does not make it a miracle cure, but certainly makes it enough to be clearly useful," he added.

The Department of Health and Social Care told Insider on Friday that both tocilizumab and sarilumab have been recommended to clinicians.

"The bottom line is that although I have a few concerns about the details of this study, if I were in intensive care with COVID-19, I would definitely want my doctors to give me tocilizumab now that I've read this paper," said Jacobs.