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severe COVID

Lisa Schnirring | News Editor | CIDRAP News July 6, 2021

Yaroslav Kryuchka / iStock

The World Health Organization (WHO) today recommended the use of anti -inflammatory monoclonal

antibodies — tocilizumab and sarilumab — alongside corticosteroids for treating patients who have severe

or critical COVID -19 infections.

In other global developments , some countries including Indonesia, Vietnam, and Bangladesh, reported

new record daily highs for infections, as COVID -19 cases continued to rise in parts of Europe.

Meta -analysis reveals life -saving impact

The WHO's treatment recommendation comes in the wake of a study published today in the Journal of

the American Medic al Association (JAMA) , in which researchers analyzed 27 randomized trials that

involved nearly 11,000 patients.

They found that the interleukin -6 antagonists tocilizumab and sarilumab reduced the risk of death and

the need for mechanical ventilation. The W HO coordinated the study, which included partners from the

United Kingdom.

The investigators found that the drugs were most effective when given with corticosteroids.

Hospitalized patients who got one of the drugs along with corticosteroids had a 17% reduc tion in death

compared with corticosteroids given alone. The combination cut the risk of mechanical ventilation or

death by 21% compared with corticosteroids alone.

Immune system overreaction is a feature of severe COVID -19 infection, and the two drugs —bot h initially

developed to treat rheumatoid arthritis — were thought to have the potential to inhibit the interleukin -6

cytokines that the immune system generates during those instances. Earlier individual studies were

inconclusive, ranging from benefit to no effect to harm. For the study, the WHO and UK researchers combined data from 27 randomized trials spanning 28

countries. Taken together, the meta -analysis included 6,449 patients who were randomly assigned an

interleukin -6 antagonist and 4,481 who received usual care or placebo.

The risk of death within 28 days was lower in those who received the drugs, and outcomes were better

in patients who were also treated with corticosteroids. For every 100 patients treated with

corticosteroids, 4 more survived. And w hen the team looked at death and mechanical ventilator

outcomes, they found that adding the drugs meant that, for every 100 such patients, 7 more will

survive.

Janet Diaz, MD, clinical management lead for the WHO's health emergencies program, said in a Kin g's

College London news release that bringing togeth er the results of international trials is one of the best

ways to determine which treatments will save lives.

"While science has delivered, we must now turn our attention to access. Given the extent of global

vaccine inequity, people in the lowest income c ountries will be the ones most at risk of severe and

critical COVID -19. Those are the people these drugs need to reach," she said.

In a related commentary , two scientists who weren't involved in the study said the treatments are

promising for hospitalized patients with progressive disease and substantial oxygen requirements. The

authors are Michael Matthay, MD, an acute respiratory disease specialist, and Anne Leutkemeyer, MD,

an infectious disease expert, both based at the University of California, San Francisco.

They said questions surround how the drugs compare to other interventions and what threshold to use

for using them, though for now, they don't seem destined for w idespread use in patients with mild

disease or in patients who have been on prolonged mechanical ventilation.

Record COVID in Southeast Asia

Indonesia's daily COVID -19 total rose to a new record high of 31,189 new cases, with a daily record 728

deaths reported, according to Xinhua , China's state news agency. Cases have been reported from all of

the country's provinces, though roughly one third of the daily cases are from Jakarta.

The country's surge is overwhelming some hospitals, as well as the supply of oxygen. Dozens of patients

reportedly died at a public hospital on the island of Java when the facility ran out of oxygen over the

weekend, accor ding to the Washington Post .

Meanwhile, Vietnam yesterday reported 1,102 new cases, the first time the country — known for its

strong public health response — has topped 1,000 in a single day, according to Reuters . The country's

latest COVID wave started in late April, and though cases have been reported across the country, Ho Chi

Minh City accounts for the most, according to the VN Express newspaper.

Article retrieved from cidrap.umn.edu/news on October 1, 2021