Drugs used to treat critically ill COVID-19 patients in hospital have long-term benefits, according to new research.
The study, published in JAMA, found that treating critically ill patients with the drugs tocilizumab and sarilumab reduced the risk of dying over six months by a quarter, compared to those who did not receive these treatments. The researchers also found that patients who received antiplatelet treatments - drugs like aspirin to prevent blood clots - had a higher probability of improved survival at six months compared to those who did not receive the treatments, although the effects were smaller.
"The results of our study are encouraging and important as they show that tocilizumab, sarilumab and antiplatelet treatments do improve outcomes at six months, improving quality of life, as well as survival, and reducing disability." Professor Anthony Gordon
The study, led by researchers at the University of Monash and Imperial College London, is the largest randomised trial to report on the effects of COVID-19 treatments on long-term survival and quality of life.
Professor Anthony Gordon, senior author of the study and Chair in Anaesthesia and Critical Care at Imperial College London, said:
"As clinicians, the initial priority in the pandemic was to find treatments that had immediate benefits for critically ill patients with COVID-19 and could save their lives. However, many patients who are discharged from hospital report a reduced quality of life and disability as a result of the virus. There is a need to see whether COVID-19 treatments could provide long-term benefits to patients. The results of our study are encouraging and important as they show that tocilizumab, sarilumab and antiplatelet treatments do improve outcomes at six months, improving quality of life, as well as survival, and reducing disability."
Critically ill COVID-19 patients in hospital are given a range of treatments such as drugs to treat the various symptoms of the virus such as difficulties with breathing and blood clots. Previous clinical trials have assessed the impact of these treatments on short-term outcomes such as organ failure or 28-day mortality. The longer-term effects of these therapies for the treatment of critically ill patients with COVID-19 were unknown.
The researchers wanted to assess the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes such as mortality, disability and quality of life at six months.
The team analysed data from 4,318 critically ill patients with COVID-19 enrolled on the Randomized Embedded Multifactorial Adaptive Platform for Community Acquired Pneumonia (REMAP-CAP) trial between 9 March and 24 June 2021 from 197 sites in 14 countries. They were followed up for six months. Patients were randomised to one or more drugs including six different groups of treatments:
- immune modulation treatment (tocilizumab and sarilumab),
- convalescent plasma – a treatment using blood plasma from recovered COVID-19 patients,
- antiplatelet therapy - drugs to prevent blood clots from forming in arteries,
- anticoagulation medicines - drugs to prevent blood clots,
- antivirals,
- corticosteroids.
The team compared the results of patients treated with each type of treatment with control groups who did not receive that treatment but received standard care.
Tocilizumab and sarilumab clearly improved six-month survival compared with the control group. For every 100 patients treated, approximately 8 more patients survived when treated compared with the control group.
Importantly, quality of life was also improved by these treatments and levels of disability were reduced. In those who survived, approximately 50 per cent of patients in the control group reported moderate, severe or complete disability at 6 months. That was reduced to 40 per cent in those treated with tocilizumab or sarilumab. Similar improvements in quality of life were also seen in those treated with anti-platelet treatment compared to those not treated with anti-platelet medication.
The team used two surveys to assess more than 1000 patients' quality of life at six months.
Patients answered questions on five aspects of quality of life – mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. The responses were given a score for each aspect from one being no problems and five being extreme difficulties or pain. Patients also answered a disability survey and their score was turned into a percentage, with 0 per cent meaning no disability and 100 per cent maximum disability.
The study is funded by National Institute of Health and Care Research (NIHR).
