A drug used to treat rheumatoid arthritis could help to save the lives of patients with severe Covid, researchers have found, and they say its benefits can be seen even when it is used on top of other medications.
Experts involved in the Randomised Evaluation of Covid-19 Therapy (Recovery) trial say baricitinib, an anti-inflammatory drug taken as a tablet, can reduce the risk of death from severe Covid by about a fifth.
However, they add that when the impact of other medications used alongside the drug are also taken into account, the risk of death could be lowered by well over 50% – although the figure will vary from patient to patient.
“What we have now is a suite of drugs which tackle the immune system at different levels, and slightly different ways, which depending on the patient and their circumstances, and their other illnesses and so on, can be used either alone or in combination and further reduce the risk of death,” said Prof Sir Martin Landray, a joint chief investigator of the trial at the University of Oxford. He said the drugs did not appear to pose undue risks.
Writing in a preprint that has yet to be peer-reviewed, the team report how they looked at outcomes for 4,008 patients hospitalised with Covid between February and December 2021 who were given usual care – which included interventions such as oxygen, the steroid dexamethasone, the arthritis drug tocilizumab, which has to be given intravenously, and the anti-viral drug remdesivir.
These outcomes were compared with those for 4,148 patients who were given baricitinib for up to 10 days in addition to usual care.
The results reveal 546 patients given usual care died within 28 days of being admitted to hospitaland 513 patients who were also given baricitinib.
“This result was consistent across the very wide range of people we studied, younger people and older people, men and women,” said Landray.
Landray noted that those given bariacitinib were also more likely to be successfully discharged alive within the first 28 days, although the size of the effect was small, and less likely to require mechanical ventilation.
The team say that when the new results are combined with data from other trials, all of which were smaller than the Recovery trial, they found baricitinib reduced the risk of death in patients hospitalised for Covid by around a fifth.
The researchers say that neither the vaccination status of patients nor the time at which patients took part in the trial – which may encompass different Covid variants – appeared to affect the results.
While concerns have previously been raised from studies of long-term users of baricitinib that the drug might increase the rate of infections or blood clots, the researchers say no signs of such side-effects were found when it was used over a short period to help tackle severe Covid.
Landray said a 10-day course of baricitinib would cost about £250, making the drug more expensive than dexamethasone, which costs about £5 for a course of treatment, but cheaper than tocilizumab, which costs about £800-£1,000, although he noted it was likely the prices paid by the NHS would be lower.
While tocilizumab acts to block a protein that can cause an overreaction of the immune system, baricitinib blocks the transmission of signals from this and similar proteins.
Prof Sir Peter Horby, also a joint chief investigator of the Recovery trial, said the results were also important given concerns that some Covid variants are resistant to certain antivirals.
Sajid Javid, the UK health secretary, welcomed the latest results for baricitinib. “This is promising news from the government-funded Recovery trial and shows once again how the UK is leading the world in identifying life-saving treatments for NHS patients,” he said. “A big thank you to all of the researchers, doctors and volunteers involved in this work. Our medical and scientific experts will now consider the results before any decisions are made on next steps.”
