Anti-inflammatory drugs may reduce deaths due to Covid-19, but they do not help speed up the recovery for those in hospital, according to a recent study.
Results from the study, published in The Journal of the American Medical Association, demonstrated that giving abatacept, cenicriviroc, or Johnson and Johnson’s Remicade (infliximab) in addition to standard of care did not decrease time to recovery for patients hospitalised with Covid-19 pneumonia. The standard of care included in this study involved Gilead Sciences’ Veklury (remdesivir) and the corticosteroid dexamethasone.
Patients who took either one of the three drugs recovered after a similar number of days compared to those who were on placebo. The investigators also measured mortality across the sub-studies by day 28 – which did show slight differences, though not statistically significant. Abatacept and Remicade led to a narrow decrease in patient deaths – a 4.1% and 4.4% difference respectively, whilst the cenicriviroc group’s mortality rose by 1.9%. A limitation with the latter group was adherence, however, as cenicriviroc is orally administered, unlike abatacept and Remicade which are infused intravenously.
Though the study did not meet any endpoints, the authors note that “expanding treatment armament” is important as SARS-CoV-2 variants may always emerge that may evade antiviral treatments. Although the World Health Organization (WHO) declared an end to the Covid-19 public health emergency, there were still over 6,000 hospitalisations due to the disease in the past week in the US. Based on statistics from March 2023, the Centers for Disease Control and Prevention state that unvaccinated adults are around five times more likely to die from Covid-19.
The JAMA trial remains a helpful scaffold with the investigators saying that other previous large-scale Covid-19 studies have not concurrently evaluated multiple agents whilst simultaneously providing a shared placebo group. Still, the study was a randomised, double-masked, placebo-controlled clinical trial (NCT04593940) that enrolled almost 2,000 patients, in comparison to other smaller open-label studies that explored similar questions. However, a limitation of this study itself was that it took place before the SARS-CoV-2 Omicron variant became prevalent.
During the pandemic, Covid-19 patients were prescribed the corticosteroid dexamethasone, with research showing that the drug reduces mortality for patients on respiratory support. There was interest in whether giving additional, targeted anti-inflammatory agents could complement steroid action. Tocilizumab, marketed as Actemra by Roche subsidiary Genentech, was given emergency authorisation by the US Food and Drug Administration (FDA) for treating hospitalised Covid-19 patients receiving systemic corticosteroids.
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“One of the fundamental questions of early Covid-19 research was whether we could dampen the inflammatory process using existing anti-inflammatory drugs,” said Dr. William G. Powderly, national principal investigator of the trial.
“Our data suggest that two of the drugs we studied can be given to reduce mortality in severely ill patients. We hope this study will be helpful in revising guidelines for best practices in treating patients hospitalized with Covid-19.”