Covid-19 patients around the world could have a better survival rate following the discovery of a treatment through a worldwide trial.
Involving New Zealand researchers, the trial's found two anti-inflammatory drugs, often used to treat rheumatoid arthritis, significantly reduce the risk of critically ill patients dying from the virus.
One of the trial’s senior researchers, Auckland City Hospital intensive care specialist Dr Colin McArthur, says the drugs, called tocilizumab and sarilumab, work to suppress the body’s natural immune response to Covid-19.
“In fighting the virus, the immune system can also cause damage to organs such as the lungs. These drugs work by stopping one of the protein signals that activate cells involved in the immune response," he told 1 NEWS.
Published in the prestigious New England Journal of Medicine today, McArthur says the findings are significant.
“We always suspected that specifically targeting the body’s immune response in the sickest patients was theoretically possible as a means of treatment, but we have now shown that it actually works.
"These findings will help critical care teams around the world improve outcomes for the most severely ill Covid-19 patients."
Researchers in many countries — including New Zealand, Europe, North America and the UK — took part.
“Patients were allocated to receive one of these drugs or to receive other usual care without the drugs, and were able to show a difference in outcomes from those two groups with a mortality rate in the treated patients falling from 36 per cent down to 27 per cent,” McArthur says.
“It's a significant result because that reduction from 36 per cent down to 27 per cent means that for every 12 patients treated, we get one extra survivor and that's quite an important treatment effect.
“It's very important for patients that have a high demand on their health systems, particularly intensive care units ... These drugs do appear to prevent people needing escalation and support in an intensive care unit.
"For those who are critically ill, it shortens their length of stay in ICU. So in both respects that reduces demand on intensive care units and enables more patients to be treated."
One of the drugs, tocilizumab, is currently funded by Pharmac for seven different indications, none of which include treatment of Covid-19.
Use of tocilizumab in New Zealand for treatment associated with Covid-19 is not currently permitted.
In a statement to 1 NEWS, Pharmac’s director of operations Lisa Williams says it’s received a clinician application to widen access to tocilizumab for use in people hospitalised with Covid-19 and it will now seek expert clinical advice on this request, which will support an informed decision.
McArthur says the drug is available in New Zealand, but not in large stocks.
“That will be something Pharmac will be looking at about appropriate drug supply, but with these results many countries will be looking to increase their supplies of these two drugs so we'll be having to work in the international market to get some as well."
Pharmac says: “We appreciate the global pressure that studies like these can place on products such as tocilizumab, and their suppliers.
”Supply of all funded medicines is critical, and we follow up with suppliers on a regular basis.
"Currently, there are no known supply concerns for tocilizumab in New Zealand and we are monitoring stock closely. However, we will continue to follow up on a regular basis to ensure ongoing supply for New Zealand patients.”
REMAP-CAP is a global trial that was started in New Zealand in 2017 to study sever pneumonia, but was adapted last year to look at ways to treat Covid-19.
It’s an ongoing, adaptive clinical trial that randomises patients to receive multiple combinations of treatments.
It involves more than 5000 Covid-19 patients at more than 290 clinical sites around the world, including 11 ICUs within New Zealand.
The New Zealand arm of the internationally-acclaimed trial is coordinated by the Medical Research Institute of New Zealand (MRINZ), the country’s leading medical research organisation.
Funding for MRINZ involvement in the trial has come from the Health Research Council and the Ministry of Health.