A drug to treat arthritis saves lives against covid

In February of last year, when the world was about to enter the worst moment of the coronavirus pandemic, an artificial intelligence system concluded that a drug already approved to treat rheumatoid arthritis could be effective against covid.

Almost two years later, a study with more than 1,500 patients admitted for covid in hospitals in 12 countries, including Spain, has just shown that this drug – baricitinib – is one of the few known treatments capable of saving lives against the disease caused by the disease. SARS-CoV-2.

The study was carried out during the second and third waves – the most deadly – and shows that if this drug is administered together with known treatments, basically dexamethasone and to a much lesser extent the antiviral remdesivir , mortality from covid is reduced by a 5% in absolute terms. This means that one life is saved for every 20 patients treated.

The results of this trial once again highlight the harsh reality of COVID treatments. Almost two years after the start of the pandemic, there are hardly any drugs that cure COVID.

It is the largest reduction in mortality recorded so far in a trial of this type, highlight the authors of the study
“We did this study when many people were not yet vaccinated and mortality was several times higher than now,” explains Vicente Estrada, head of infectious diseases at the Hospital Clínico de Madrid and signatory of the work. “Now the patients that we have are deniers who have not wanted to be vaccinated and older people with the complete regimen who are very fragile,” he says. “Although the situation is less serious, we continue to die and this drug can prevent it in part,” he adds.

Baricitinib – under the brand name Olumiant – is a drug from the US company Lilly, which has funded the study. It was chosen by the artificial intelligence system because it reduces cytokines. These inflammatory proteins produced by the immune system cause the famous ” cytokine storm ” that can kill the patient.

Baricitinib has been shown to reduce the mortality of hospitalized patients who are in an intermediate stage of covid. The initial phase of infection is behind us and patients already show pneumonia in both lungs and clear signs of inflammation. They may need oxygen but have not yet fully fallen into the inflammatory storm or entered the ICU. It is at this point that baricitinib can prevent the train from “completely derailing”, in the words of Eugene Wesley Ely , a physician at Vanderbilt University (USA) and lead author of the work.

This is the largest reduction in mortality recorded so far in a trial of this type, highlight the authors of the work, published in The Lancet Infectious Diseases . In June 2020, dexamethasone was found to reduce absolute mortality by 3%. And in February of this year it was found that if the monoclonal antibody tocilizumab is added to this, the absolute mortality is 4% lower . The antiviral remdesivir, on the other hand, has not been clearly shown to prevent deaths.

“The most important thing is that we show that dexamethasone and baricitinib are complementary”, highlights Estrada. “Now this drug is only recommended for covid patients who cannot take corticosteroids such as dexamethasone. We propose that if these results are confirmed in more studies, it be approved together with dexamethasone for all hospitalized patients who are in the stage described in the study ”, adds Estrada.

The US health authorities have approved the use of this drug in these types of patients – admitted who receive oxygen but have not yet reached the point of maximum severity or admission to the ICU.

“Without drugs, the mortality of patients in this study would be around 16%”, explains Jesús Sierra, coordinator of the registry of the Spanish Society of Hospital Pharmacy , a database of 16,000 patients to identify drugs associated with lower mortality due to covid. “Dexamethasone would reduce it to 13% and adding baricitinib would remain at 8%, almost half,” he adds. “The cost per patient is 325 euros, so avoiding a death would mean an expense of about 6,500 euros,” he details.

“This is a new positive data that, however, is not a panacea, as it shows how difficult it is to win the battle against this infection in the most exposed population”, highlights Marcos López Hoyos, president of the Spanish Immunology Society. The expert is confident that, in addition to completing the vaccination, perhaps in the coming months data will begin to be known about other experimental drugs, especially antivirals capable of preventing the replication of the virus and therefore the most serious phases of the disease. Among them is plitidepsin, an antiviral manufactured in Spain that was 100 times more powerful than remdesivir .

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