NEWS
Second breakthrough in major COVID trial
A UK study involving Addenbrooke’s patients has found that a drug used to treat arthritis reduces the chances of severely ill patients dying from COVID-19. Cambridge University Hospitals NHS Foundation Trust is one of 117 hospitals across the UK participating in the Oxford University led RECOVERY trial.
Latest results show the anti-inflammatory drug tocilizumab reduces the risk of hospitalised patients dying from COVID-19. It also found the drug led to fewer patients being put on a ventilator machine and they were discharged from hospital more quickly. In the UK tocilizumab is approved for the treatment of rheumatoid arthritis. This is the latest success for the RECOVERY trial. In June 2020, it found the widely available steroid, dexamethasone, reduced death for patients with severe COVID-19 and became part of standard care around the world. CUH intensive care specialist, Dr. Charlotte Summers, commented: “This is a huge step forward for the treatment of patients with COVID-19. Like many ICU doctors I have witnessed the devastating consequences of COVID-19, but every breakthrough like this brings more hope that we will control this terrible disease.” Tocilizumab was added to the trial in April 2020 for COVID patients who required oxygen and had evidence of inflammation. It stopped last month when experts concluded sufficient patients had been enrolled to
establish whether the drug helped. A total of 2022 patients at participating hospitals received tocilizumab by intravenous infusion and were compared with 2094 allocated to usual care alone. 82% of patients were taking a systemic steroid such as dexamethasone. Treatment with tocilizumab significantly reduced deaths. 596 (29%) of the patients in the tocilizumab group died within 28 days compared with 694 (33%) patients in the usual care group. This means that for every 25 patients treated with tocilizumab, one additional life is saved. Tocilizumab also increased the probability of discharge alive within 28 days from 47% to 54% in all patient subgroups, from those requiring oxygen via a simple face mask, to those requiring mechanical ventilators in an intensive care unit. It also reduced the chance of progressing to invasive mechanical ventilation or death from 38% to 3%, although there was no evidence that tocilizumab had any effect on the chance of successful cessation of invasive mechanical ventilation.
The data showed that for patients with hypoxia and significant inflammation, treatment with a systemic corticosteroid (such as dexamethasone) plus tocilizumab reduced mortality by about one third in patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation.
GPs fear reprisal over delayed
referrals Nearly 4 in 5 GPs in the UK (77%) are concerned about facing investigation if patients come to harm as a result of delayed referrals or non-COVID-19 services being unavailable or limited, according to a survey by the Medical Protection Society (MPS). The MPS survey of 688 UK GPs, follows a report from Macmillan which estimates that there are around 50,000 ‘missing’ cancer diagnoses across the UK. MPS said it expects a significant number of medicolegal disputes, complaints and investigations where delayed referrals have seriously impacted on patients’ prognoses and outcomes due to circumstances beyond their doctors’ control. The impact of an investigation on already emotionally and physically exhausted doctors would be significant, it added. Dr. Rob Hendry, at MPS, highlighted the need to protect doctors from unfair investigation during these challenging times: “Doctors feel vulnerable when it comes to delayed referrals and the potentially devastating impact on their patients through no fault of their own. The Health Secretary agreed to keep the need for emergency laws under review, and we would again urge him to consider what protections need to be put in place,” he commented.
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