UCLH has opened a trial to see if a drug can suppress the overactive immune system response found in seriously ill Covid-19 patients. It is the first study at UCLH to look at the treatment approach known as immunomodulation.
A consensus has emerged among front-line clinicians at UCLH and beyond that drugs that alter the immune system may hold more promise than other drugs such as antivirals when treating COVID-19.
Researchers in the COVACTA study led at UCLH by Dr Claire Roddie and Prof Kwee Yong will investigate whether tocilizumab (TCZ) developed by Roche can dampen the overly high immune response clinicians have observed in patients.
This immune response is dangerous and can lead to deterioration. Early evidence from China suggests that using the drug to modify the immune response can improve symptoms and patient outcomes.
In this study, researchers will evaluate the safety and effectiveness of TCZ compared with a placebo in combination with standard of care in COVID-19 patients with severe pneumonia hospitalised at UCLH. Patient outcomes will be assessed after 28 days and look at whether and for how long patients required mechanical ventilation; whether and for how long patients had to be admitted to the ICU; and the time taken to discharge.
TCZ was approved in 2017 by US authorities for the treatment in some patients of a serious overreaction of the immune system known as cytokine release syndrome (CRS) which is similar to the immune response in COVID-19.
Doctors in China have used TCZ on an off-label basis to treat Covid-19 patients with pneumonia, and a review of 21 patients who were given the drug suggests it was highly effective at improving all symptoms of the disease, including reducing fever. A larger study in China is now underway looking at TCZ and the China National Health Commission has listed the drug as one treatment option for severe or critical forms of COVID-19 pneumonia.
Dr Roddie said: “Clinical experience suggests that immunomodulation is going to be a key approach in tackling Covid-19 and may be more helpful than other approaches. We hope to be able to build on emerging data from China and show that tocilizumab is beneficial in Covid-19 patients who experience this overactive immune response.”
