Greater Manchester hospitals contribute to study which shows tocilizumab reduces deaths in patients hospitalised with COVID-19

The NIHR-supported RECOVERY trial, which is taking place at over 10 hospitals across Greater Manchester, has shown that an anti-inflammatory rheumatoid arthritis treatment reduces the risk of death for hospitalised patients with severe COVID-19.

Researchers also found that the same drug, tocilizumab, reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation.

Almost 2,160 patients have taken part in the RECOVERY trial at hospitals across Greater Manchester, East Cheshire and East Lancashire, with over 35,000 taking part across the country.

Last year, the RECOVERY study was the world’s first to show that dexamethasone - a cheap and available steroid - reduces the risk of dying from COVID-19.

The latest results from the study also suggest that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid - such a dexamethasone - alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation.

RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care.

The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab - beyond those critically ill on mechanical ventilation.

As part of the trial, 2022 patients were randomly allocated to receive tocilizumab by intravenous injection. Results were compared with 2094 patients randomly allocated to usual care alone. 82% of randomised patients were also taking a systemic steroid such as dexamethasone.

The study showed that for every 25 patients treated with tocilizumab, one additional life would be saved. Benefits were seen in all subgroups, including patients requiring oxygen via a simple face mask, in addition to patients in intensive care requiring mechanical ventilators.

For patients who were not on invasive mechanical ventilation when entered into the trial, tocilizumab also significantly reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 33%.

RECOVERY: NIHR funding and support

The study is jointly funded by the NIHR with UKRI. While delivery of the study is supported by the NIHR Clinical Research Network and the devolved administrations, working alongside the NHS, who together have helped recruit over 35,000 participants at 177 hospital sites across the country.

Dr Abdul Ashish is NIHR Clinical Research Network Greater Manchester specialty lead for Respiratory Disorders and Principal Investigator for the RECOVERY trial at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL). More than 370 patients have taken part in the trial at WWL, which is among the highest recruiting NHS trusts to the tocilizumab arm of the trial in the country.

Dr Ashish said: “It is very pleasing to see these excellent results which represent another landmark moment in the research response to COVID-19. We couldn’t have gathered this vital data without the dedication of staff who have enabled the RECOVERY trial to be carried out at hospital sites across our region and, of course, the patients who have agreed to be part of this research.

“RECOVERY was the first COVID-19-related trial to get under way here at WWL in March 2020 and our trust has been proud to play a significant part in its delivery and offer our patients the opportunity to be part of this urgent public health study.”

Professor Nick Lemoine, Medical Director of the NIHR Clinical Research Network said: “These latest results for tocilizumab are highly significant and will undoubtedly help save lives - not just in the UK but around the world. They show that tocilizumab - a widely available arthritis treatment - can save lives, shorten hospital stays and decrease the likelihood of requiring mechanical ventilation for hospitalised COVID-19 patients.

“Through our programme of urgent public research - working closely with the RECOVERY team and NHS hospital staff right across the UK - the NIHR has helped over 35,000 patients take part in this flagship treatment study. In doing so, RECOVERY has been able to provide data which has now given the world two life saving treatments against this dreadful disease.”