Arthritis drug treats virus
Banner Health officials in Arizona hope a drug used to treat rheumatoid arthritis can help them save their most critically ill COVID-19 patients.
Banner Health officials hope a drug used to treat rheumatoid arthritis will help improve outcomes in their most critically ill COVID-19 cases.
The Phoenix-based nonprofit health system this month began using the anti-inflammatory drug tocilizumab to treat a specific subset of its sickest patients.
Tocilizumab has had mixed results on COVID-19 patients in numerous trials, and reports conflict about its usefulness in treating people infected with the new coronavirus.
The drug has not been approved by the U.S. Food and Drug Administration for treating COVID-19 patients, nor does it have a government Emergency Use Authorization.
But recent data on the drug’s use in severely ill COVID-19 patients is giving Banner Health leaders some optimism for a select group of critically ill COVID-19 patients at risk of dying.
As of Monday, more than 1,000 patients with confirmed and suspected COVID-19 were in ICU beds in Arizona hospitals, and 687 were connected to mechanical ventilators. Many COVID-19 patients who are placed on a ventilator will linger for weeks but not survive.
The drug, when given according to a strict protocol to a specific population of COVID-19 patients hospitalized in intensive care units, may reduce the number of days those patients need breathing assistance, including from mechanical ventilators, said Dr. Jason Brown, chief medical officer for Banner Pharmacy Services.
Physicians and nurses have improved their knowledge of patients infected by the SARS-CoV-2 virus that causes the COVID-19 illness since the onset of the pandemic, and have adopted techniques like “proning” patients — placing them on their stomachs — to improve their oxygenation and improve their chances for survival.
But in terms of drug treatments to reduce mortality from COVID-19, few medications have been proven effective.
Arizona hospitals make different decisions about treatment
Not all hospitals and hospital systems in Arizona are treating their COVID-19 patients with the arthritis drug right now.
Dignity Health, which is one of Arizona’s largest health systems, is “not currently using tocilizumab or Interleukin 6 inhibitors for the treatment of COVID-19 as it is still under review and has not yet been granted either an FDA approval or an Emergency Use Authorization for treatment of COVID-19,” Dignity spokeswoman Abby Friedemann wrote in email.
Since the “true effect on clinical outcomes of tocilizumab are not welldefined,” it’s being used on a case-bycase basis for COVID-19 patients at the Mayo Clinic in Arizona, critical care chief Dr. Ayan Sen wrote in an email.
Mayo has used the drug in the past on COVID-19 patients with acute respiratory distress syndrome and will use the drug based on evolving evidence on a case-by-case basis, Sen said. Since studies have had varying results, more evidence is needed about the drug’s benefits and harms on patients with COVID-19, he said.
The Arizona Department of Health
Services’ authority does not include regulating or requiring the use of certain drugs, spokeswoman Holly Poynter wrote in an email, and the agency encourages individuals to speak with their health care providers if they have questions about specific treatments, she said.
The National Institutes of Health recommends against the use of Interleukin 6 receptor antagonists such as sarilumab or tocilizumab for the treatment of COVID-19, except in a clinical trial, Poynter wrote.
Banner Health’s position is that it is making the treatment option available for critically ill COVID-19 patients because recent literature has shown it may be beneficial for them.
Study found tocilizumab improved survival in patients
A positive sign for Banner Health was a recent clinical trial of 800 patients that found that tocilizumab may benefit seriously ill COVID-19 patients, including reducing the relative risk of death, if administered quickly after development of critical illness.
The study led by British researchers was published Jan. 7 in the preprint server medRxiv. A preprint is a version of a scientific manuscript publicly posted prior to peer review, which is the standard for publication in a scientific journal.
The U.K. government and England’s National Health Service on Jan. 8 issued updated guidance encouraging the use of tocilizumab in treatment of COVID-19 patients who are admitted to intensive care units.
Tocilizumab may successfully target the hyperinflammatory syndrome that some COVID-19 patients develop, Brown said.
The protocol Banner officials are following requires giving the medication, in combination with corticosteroids, to patients with COVID-19 within 24 hours of being placed on a CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), high flow oxygen, mechanical ventilation or are requiring vasopressor medications to increase their blood pressure in an ICU setting, Brown explained.
“It’s very sick patients; I think that is the key. The types of trials to date have been kind of variable in terms of the patient population or the degree of severity of the patients’ illness,” Brown said. “The most recent trial that came out was more promising in terms of the outcomes and the select patient population to use this specific medication in.”
Banner’s Pharmacy and Therapeutics Committee reviews all recent scientific literature on COVID-19 treatments on a frequent basis, Brown emphasized, and if there is any new literature about tocilizumab, the committee will adjust the criteria for use.
“The ideal hope is that it’s going to reduce the number of days that patients are required to have respiratory or cardiovascular support,” Brown said.
If patients have reduced days of needing help breathing, their chances for survival improve. Arizona’s death rate from COVID-19 has been climbing during the latest surge and as of Monday had the highest rate of new deaths due to COVID-19 in the nation.