‘Toci’ and COVID; Exercise for Arthritic Knees; It’s TTHealthWatch!

‘Toci’ and COVID; Exercise for Arthritic Knees; It’s TTHealthWatch!

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.

This week’s topics include exercise for knee osteoarthritis, tocilizumab for COVID-19, gut flora and their role in health and disease, and heparin and COVID infection.

Program notes:

0:41 Tocilizumab and COVID

1:46 All needed oxygen

2:48 How expensive?

3:18 Exercise and knee osteoarthritis

4:18 High or low intensity strength training

5:18 Very comprehensive study

6:18 Keeping people in the study for 18 months

6:38 Heparin for reducing blood clots in COVID

7:40 Subcutaneous injection

8:41 Study coming shortly

9:10 Human gut microbiome and health

10:10 Driven by healthy and plant-based foods

11:10 Less of one bug in the gut may be associated with cardiovascular disease

12:10 Is it a cause or an effect?

13:15 End

Transcript:

Elizabeth Tracey: Is exercise of any benefit whatsoever in knee osteoarthritis?

Rick Lange: Do people with COVID benefit from a blood thinner?

Elizabeth: A really exhaustive look — so far — at the human gut microbiome and how it may be related to disease.

Rick: And a different anti-inflammatory medication for people with COVID and respiratory problems.

Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of the Texas Tech University Health Sciences Center in El Paso, where I’m also the dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, we’re still top of mind with COVID, so I’m going to let you choose one of yours to start with.

Rick: Elizabeth, let’s talk about this anti-inflammatory agent, and I called it new — it’s actually not new. It’s been used for rheumatoid arthritis, but it’s new for the use of COVID. This was in a particular group of individuals. These are individuals that have decreased oxygen saturation — that is, they’re having hypoxic respiratory problems, lung problems, from COVID.

We know that there are various therapies. Early on, there’s monoclonal antibodies before people get into the hospital; once they get in and they’re mildly affected, remdesivir; but those that are most severely affected — those on a ventilator or about to — benefit from high-dose steroids.

What that alludes to is the fact that our immune system is responsible for some of the lung damage, the inflammation. There is a monoclonal antibody called tocilizumab, which has been used for rheumatoid arthritis because it’s also an inflammatory condition. Specifically, it inhibits what’s called interleukin 6.

They took over 4,000 adults that had COVID that had evidence of inflammation — elevated C-reactive protein — and they all had some requirements for oxygen — some were on a ventilator — and they randomized them to the usual care or a single infusion of tocilizumab. Sometimes, if they wanted to, they could give a second dose the next day, and the simple outcome was, how did they do with regard to mortality?

What they discovered was that the addition of tocilizumab to usual care, 29% of the individuals that received tocilizumab died within 28 days versus 33% of the patients who did not receive it. Overall, that was a 14% reduction in mortality.

Elizabeth: Let’s just remind everyone that this is published on the preprint server medRxiv and that this is part of the RECOVERY trial, that giganto and, in my mind, an incredibly well-designed study that’s taking place in the U.K. that’s looking very rigorously at a lot of these things. We can say that our dexamethasone outcomes were really a result of the RECOVERY trial also.

Let’s go back, though, to “toci” — that’s how I’ve heard people abbreviate it when they’re talking about it — how expensive is this?

Rick: Elizabeth, it doesn’t say in this particular article so I can’t address that, but the paper does allude to the fact that we need to do a cost-benefit analysis. Now, you’re reducing mortality, but you’re right — we do have to ascertain what the cost is and also availability. Now, the nice thing is, it’s not a new medication that we have to look for side effects. It’s been around for a while, so we’re just repurposing it.

Elizabeth: We love those repurposed things because, of course, we already have abundant experience with them and that’s a great thing. Let’s turn to something way more pedestrian in JAMA Internal Medicine. This is a study taking a look at something that’s just so very, very common. That’s knee osteoarthritis.

In point of fact, as we know, osteoarthritis is the #1 form of arthritis and a leading cause of disability among adults worldwide and the knee, of course, a very common joint to be impacted. In this study, they said, “Hey, if we put people on different types of exercise regimens or usual care, will we be able to ameliorate the pain and the disability that go with knee osteoarthritis?”

They had 377 community-dwelling adults — I would like to have seen more people, frankly — and they also had varying BMIs, so ranging from 20 to 45. They didn’t stratify this. This is one criticism I have of this study because we know that those increasing BMIs really do exacerbate this condition, but in any case, they had one of three groups, a high-intensity strength training group, a low-intensity strength training g

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