In a new study, researchers found that a drug normally used in rheumatoid arthritis and cancer treatments, tocilizumab, improves hospital survival in critically ill patients admitted to the intensive care unit (ICU).
They utilized its statewide observational database of more than 5,000 hospitalized COVID-19 patients.
The researchers have updated the U.S. Food and Drug Administration and other national leaders of the findings to help accelerate improved outcomes.
The research was conducted by a team at Hackensack Meridian Health.
The study included 630 patients who were admitted to the ICUs of 13 Hackensack Meridian Health hospitals from March 1 to April 22—the height of the pandemic in New Jersey.
Among other treatments, tocilizumab was considered for off-label usage for the patients whose respiratory symptoms were declining; many of whom were requiring mechanical ventilator support.
In the observational study, 210 patients received tocilizumab, and the other 420 did not.
COVID-19 has three phases: the early or viral phase (with fast viral replication), the pulmonary phase (marked by inflammation and pneumonia as the body tries to fight the virus in the lungs) and the inflammatory phase (in which excessive inflammation reaches and affects many organs and patients are often in the ICU).
As part of both the pulmonary and inflammatory phases, the immune system is “supercharged” and secretes in the blood numerous cytokines, particularly interleukin (IL)-6, which induces further inflammation.
Tocilizumab is a monoclonal antibody, which binds and blocks the interleukin (IL)-6 receptor and helps damper the inflammatory response.
The activity of tocilizumab was first shown in chimeric antigen receptor (CAR) T-cell therapy, where a similar phenomenon of overactive and growing T cells induce a “cytokine storm.”
This provided a rationale to try tocilizumab in COVID-19 patients.
The findings showed a strong decrease in hospital-related deaths among the patients who received the tocilizumab: a roughly 36 percent decrease in hospital-related mortality among the ICU patients who received the drug, as compared with patients in the ICU who didn’t receive it.
Importantly, it appeared that higher levels of a blood test marker of inflammation, C-reactive protein, could predict which ICU patients might benefit most from the tocilizumab therapy, potentially allowing doctors to tailor therapy to those most in need.
The team says they need to know more as soon as possible.
Their database has allowed them to rapidly expand the knowledge of COVID-19 throughout the Hackensack Meridian Health hospital network. They are moving fast to help guide interventions—and potentially save lives.
One author of the study is John Theurer Cancer Center hematologist-oncologists Andrew Ip, M.D.
The study is published in The Lancet Rheumatology.
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