This arthritis drug may help treat severe COVID-19

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In a new study, researchers report the use of the rheumatoid arthritis drug anakinra to treat COVID-19 patients.

They found that high-dose anakinra was safe and was linked to respiratory improvements and reduced cytokine storm in 72% of patients.

This study is the first to suggest that a high dose of the arthritis drug anakinra may be able to block the overreaction of the immune system caused by COVID-19.

The research was conducted by a team at the Vita-Salute San Raffaele University.

Most people with COVID-19 experience only mild symptoms, but in severely affected patients the immune system overreacts, triggering a storm of immune proteins called cytokines.

The cytokines contribute to hyperinflammation, leading to acute respiratory distress syndrome (ARDS) and reducing oxygen levels in the blood. ARDS is the main cause of death from coronavirus disease.

Of patients admitted to intensive care units with COVID-19 and ARDS, the estimated death rate ranges from 28% to 78%.

Patients’ breathing is supported until inflammation recedes, but the number of patients needing ventilation can exceed the number of intensive care units with mechanical ventilators.

Treatments are urgently needed to improve the prognosis of critically ill patients treated outside of ICUs.

Until a vaccine is available, scientists urgently need to find a way to help people survive the most severe symptoms of COVID-19 and to do that without overwhelming the intensive care capacity of hospitals.

A treatment that has already met strict safety tests and that is available in sufficient quantities to meet the needs of the current pandemic is ideal

The drug anakinra is already approved by the US Food and Drug Administration and the European Medicines Agency to treat rheumatoid arthritis, Still’s disease, and recurrent fever.

It works by blocking the proinflammatory cytokine IL-1.

In the study, all 29 patients received standard care as well as the drug treatment. They were compared to 16 patients who received standard care only.

The team found intravenous anakinra might be effective and safe in treating cytokine storm syndromes generally.

Compared with other cytokine-blocking agents, anakinra has a strong safety record and a short half-life, making it suitable for critically ill patients.

The team found the treatment with high-dose anakinra was linked to reductions in serum C-reactive protein and with progressive improvements in respiratory function in 21 (72%) of 29 patients.

Survival was 90% (26 out of 29). Five of 29 patients (17%) needed mechanical ventilation.

The authors report that high-dose anakinra was generally safe. Among adverse effects, four patients (14%) in the high-dose anakinra group had bacteremia (bacteria in the blood), compared to two patients (13%) in the standard treatment group.

Discontinuation of anakinra was not followed by inflammatory relapses.

The authors caution that the findings need to be validated with a controlled trial, conducted over a longer period to check for long-term outcomes.

The lead author of the study is Prof Lorenzo Dagna, head of the Unit of Immunology, Rheumatology, Allergy, and Rare Diseases at San Raffaele Hospital and Vita-Salute San Raffaele University.

The study is published in The Lancet Rheumatology.

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