Arthritis drug helped cure 95% of critically ill coronavirus patients

Promising arthritis drug being used to treat coronavirus patients in China helped to cure 95 PER CENT of critically ill patients, scientists claim

  • Tocilizumab, marketed as Actemra, is taken by patients with rheumatoid arthritis
  • It reduces inflammation, which is considered a complication of COVID-19
  • It causes lung damage and organ failure, eventually death in most cases
  • Chinese doctors gave it to 20 patients during the peak of the countries epidemic
  • Nineteen were discharged within 14 days despite being critically ill
  • Actemra has now been approved for use in China and for trials in the US
  • Coronavirus symptoms: what are they and should you see a doctor?

An arthritis drug being used to treat coronavirus in China cured 95 per cent of critically ill patients, scientists have claimed.

Tocilizumab, marketed as Actemra, is taken by patients with rheumatoid arthritis to lower inflammation.

Chinese doctors gave it to 20 patients during the peak of the country’s epidemic, and claim 19 were discharged from hospital within two weeks. 

The findings come as scientists worldwide urgently hunt for new ways to combat the deadly infection, which has so far affected almost 450,000 people and killed almost 20,000.

Because tocilizumab is an existing drug, it could be fast tracked into experiments by regulators.

Health officials in China have since approved Actemra to treat coronavirus patients with serious lung damage as a result of high inflammation – the body’s response to the coronavirus. 

It has already been green-lighted by the FDA for trials on patients in the US, it was revealed yesterday. 

No patients in the UK are thought to have taken the drug yet, in trials or clinical care. 

Tocilizumab, marketed as Actemra, cured 90 per cent of critically ill coronavirus patients in an early trial in China. It is used to treat arthritis 

Tocilizumab is used to treat adults with rheumatoid arthritis, as well as certain types of childhood arthritis. 

It is typically marketed under the names of RoActemra and Actemra, produced by the Swiss pharmaceutical firm Roche.

The prescription medicine works by reducing levels of IL-6 protein in the body, which people with rheumatoid arthritis or another autoimmune conditions have too much of.

If there is too much IL-6, it can cause inflammation and damage. Tocilizumab blocks the effects, and has become a go-to for inflammatory disease treatment.

The drug is controversial, however, because it has been linked to a spate of deaths, Stat News reports. 

Experts said the FDA should immediately consider some evidence that Actemra can lead to heart failure, pancreatitis, heart attacks, strokes, and interstitial lung disease, a sometimes-fatal scarring of lung tissue.

Doctors in China trialled tocilizumab to prevent an overreaction of the immune system seen in some coronavirus patients.

Called a ‘cytokine storm’, the body’s immune response can go into overdrive and produce inflammation.

The overreaction of the immune system is considered a major factor behind catastrophic organ failure and death in some coronavirus patients.

It’s not clear the extent to which the really severe pneumonia symptoms seen in critically ill COVID-19 patients are due to the virus, or complications with the body’s response.

Doctors in China were the first to try tocilizumab against the deadly coronavirus that causes COVID-19 in early February.

Patients, who were given routine therapies along with the drug, were diagnosed as severe or critical.

They were being treated at two separate hospitals in the eastern province of Anhui in China – The First Affiliated Hospital of University of Science and Technology of China and Anhui Fuyang Second People’s Hospital. 

CT scans also showed damage to the lungs reduced significantly around the fourth and fifth day of treatment. Pictured left, the lungs of a 55-year-old man, centre, a 82-year-old man and right, a 32-year-old patient

Some patients in the trial were diagnosed at the First Affiliated Hospital of Nanchang University. Medics are pictured on an intensive care ward there


Tocilizumab is used to treat adults with rheumatoid arthritis, as well as certain types of childhood arthritis. 

It is typically marketed under the names of RoActemra and Actemra, produced by the Swiss pharmaceutical firm Roche.

RoActemra was hailed as the first innovation in the field of treating rheumatoid arthritis (RA) for ten years when it was approved by the NHS in 2012 after a long battle over pricing.

The prescription medicine works by reducing levels of IL-6 protein in the body, which people with rheumatoid arthritis or another autoimmune conditions have too much of.

If there is too much IL-6, it can cause inflammation and damage. Tocilizumab blocks the effects, and has become a go-to for inflammatory disease treatment. 

Doubts have been raised about the safety of tocilizumab, which has a long list of side effects including a cough or sore throat, blocked or runny nose, headaches or dizziness, mouth ulcers, high blood pressure, weight gain and stomach problems.

Tocilizumab has been shown to increase the risk of infections in patients with rheumatoid arthritis, including pneumonia and upper respiratory tract infections, according to Versus Arthritis.

Trials on patients with RA before approval were not designed to assess long-term efficacy and safety.

The Food and Drug Administration has received reports on 1,128 people who died after taking Actemra, according to a report by Stat News in 2017. It said the FDA declined to comment about Actemra.

Within a few days, patients’ fever returned to normal and all other symptoms improved remarkably, Dr Xiaoling Xu and colleagues report.

Fifteen of the 20 patients involved in the trial were able to have their oxygen intake lowered, while one patient was taken off completely.

Seventeen of the patients had seen levels of their white blood cells, called lymphocytes, drop. But on the fifth day, this returned to normal in ten of the patients.

Nineteen patients (95 per cent) were discharged after 13 and a half days. The other patient is recovering well, the study said.

CT scans also showed damage to the lungs reduced significantly around the fourth and fifth day of treatment. 

The authors concludes: ‘Tocilizumab is an effective treatment in severe patients of COVID-19, which provided a new therapeutic strategy for this fatal infectious disease.’

The researchers did not compare the drug to a placebo or any other drugs in the small study. The paper was published on ChinaXiv, a website which hosts scientific research which has not been peer-reviewed. 

At the beginning of March, China’s National Health Commission published a treatment guideline that allows the tociluzumab to be used to treat coronavirus patients who have high IL-6 levels and who show serious lung damage.

Karsten Kleine, a spokesperson for Roche, told NBC News that the drug company ‘is in active discussions with the FDA, as well as government bodies and institutions around the world, to initiate clinical trials that evaluate the safety and efficacy of Actemra (tocilizumab) for the treatment of severely ill COVID-19 patients.’

The FDA announced yesterday that it would be The FDA had approved the initiation of a large trial if Actemra.

The phase III clinical trial launched by biotechnology company Genetech, will compare the drug to a placebo while with the combination of standard care for patients with severe COVID-19 pneumonia.

It will involve approximately 330 patients across the US and other countries who will be tracked for 60 days, with recruitment set to begin in early April.

Genentech also announced in a press release that the company is providing 10,000 vials of tocilizumab to the United States Strategic national stockpile for potential future use.

Alexander Hardy, chief executive officer of Genentech, said in the press release: ‘We thank the FDA for rapidly expediting the approval of this clinical trial to evaluate Actemra in critically ill patients suffering from pneumonia following coronavirus infection and we’re moving forward to enroll as quickly as possible.’

Research in China is ongoing – the country will test Actemra with a further 188 coronavirus patients in a study running until May 10.

There is no published clinical trial data on the drug’s safety or efficacy against the virus, Roche admitted.

MailOnline have contacted the MHRA for comment. 


What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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