In a new study, researchers found that the clinically approved anti-inflammatory drug anakinra used to treat rheumatoid arthritis improved respiratory function in patients with severe COVID-19.
The eight patients also had a condition called secondary hemophagocytic lymphohistiocytosis (sHLH), which is characterized by overactivation of the immune system and organ failure.
One patient, who did not require mechanical ventilation, improved rapidly after starting treatment with the drug and was discharged from the hospital 9 days later.
But the therapy did not prevent three out of seven patients on ventilators from dying, and it’s not yet clear whether it improves mortality rates.
The research was conducted by a team at the Kapodistrian University of Athens.
The team says these data argue that the administration of anakinra may be a viable treatment in severe COVID-19 with sHLH.
The death rate in patients with severe COVID-19 admitted to intensive care units is estimated to be between 50% and 65%.
Severe complications of COVID-19 are thought to be driven by inflammatory responses, particularly through signaling molecules called interleukin 1β (IL-1β) and interleukin 6 (IL-6).
The overproduction of IL-1β by immune cells called macrophages can cause sHLH, also known as macrophage activation syndrome, which is characterized by low counts of blood cells, excessive blood clotting, kidney injury, and liver dysfunction.
Anakinra inhibits IL-1β signaling and has been shown to reduce the mortality of patients with signs of sHLH by 30%.
In the new study, the researchers tested whether anakinra could effectively treat severely ill COVID-19 patients with pneumonia and sHLH.
Seven of the eight patients were males who had respiratory failure, were on ventilators in ICUs in Greece, and had serious underlying conditions such as heart disease and high blood pressure.
They were treated with anakinra intravenously 200 mg every 8 hours for 7 days. They also received treatment with the antimalarial drug hydroxychloroquine and broad-spectrum antibiotics. The researchers monitored their outcomes over the course of 4 weeks.
The team found anakinra treatment improved the majority of laboratory findings and decreased signs of sHLH in the ICU patients.
All of them showed improved respiratory function, as indicated by a 15% to 117% increase in the ratio of partial pressure arterial oxygen and the fraction of inspired oxygen (PaO2/FiO2), which compares the oxygen level in the blood to the oxygen concentration that is breathed.
Moreover, six patients needed a lower dose of drugs that increase blood pressure. Although three of the ICU patients died, previous studies have shown that sHLH can lead to death rates as high as 67%.
The team believes that anakinra has the potential to improve outcomes in patients with severe COVID-19.
Larger clinical studies are warranted to validate these results and demonstrate the usefulness of anti-IL-1 therapy when COVID-19 is complicated by sHLH.
The lead author of the study is Evangelos J. Giamarellos-Bourboulis.
The study is published in the journal Cell Host & Microbe.
Copyright © 2020 Knowridge Science Report. All rights reserved.
