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In the fight to find drugs that outperform Covid-19, researchers from Italy report encouraging results from a small study on a rheumatoid arthritis drug already in use.
The drug, anakinra, may help calm the uncontrolled immune response known as a “cytokine storm,” which threatens some patients with severe Covid-19.
“Until a vaccine is available, we urgently need to find a way to help people survive the most severe symptoms of Covid-19, and to do so without overwhelming the intensive care capacity of hospitals,” explained the study author, the Dr. Lorenzo Dagna in a news story. free from The Lancet Rheumatology. His team published the findings in the magazine on May 7.
“A treatment [like anakinra] that has already undergone strict safety tests and that it is available in sufficient quantities to meet the needs of the current pandemic is ideal, “said Dagna, who heads immunology and rheumatology at San Raffaele Hospital in Milan.
‘Slow down’ the immune system
Most people with Covid-19 have only mild symptoms, but seriously ill patients often develop an overreaction of the immune system that triggers a storm of immune proteins called cytokines.
This cytokine “storm” contributes to hyperinflammation, leading to acute respiratory distress syndrome (ARDS) and reduced oxygen levels in the blood. ARDS is the leading cause of death in patients with Covid-19.
Could an anti-inflammatory medication like anakinra help curb an out-of-control immune system?
To help find out, the new study tracked the results of 29 elderly and seriously ill patients in Italy. These patients were treated with non-invasive ventilation (continuous positive airway pressure or a CPAP machine), along with three experimental treatments.
Those treatments included the antimalarial drug hydroxychloroquine, antiviral drugs lopinavir / ritonavir, and daily high-dose intravenous infusions of anakinra.
The results for this group of 29 patients were compared with those of 16 similar patients who received the same care, except for the use of anakinra.
Recurring signs of cytokine storm
After three weeks, the addition of high-dose anakinra infusions was associated with reduced signs of cytokine storm and improvement in respiratory function in 21 (72%) of the 29 patients, the study found. Ninety percent (26 of 29) survived; five (17%) required mechanical ventilation.
But most of the 16 patients who had not received anakinra had persistent or recurring signs of cytokine storm. Respiratory function improved by half, and 56% (nine of 16) survived. One patient received mechanical ventilation (6%).
The Italian researchers emphasized that the study was observational and that randomized controlled trials are needed to fully assess the effects of anakinra in patients with Covid-19.
Anakinra is currently approved by the United States Food and Drug Administration to treat rheumatoid arthritis, an inflammatory arthritis known as Still’s disease and recurrent fever. The drug blocks the cytokine IL-1 that causes inflammation.
Dr. Amesh Adalja is a principal investigator at the Johns Hopkins Center for Health Safety in Baltimore. He reviewed the new findings and called them significant, saying they should spur further research.
“It is important that this is studied in a randomized controlled manner,” he said, adding that blocking IL-1 could be an important aspect of caring for patients who have a hyperinflammatory state.
Progressive improvement of respiratory function.
“There has been a great deal of interest in trying to modulate this inflammatory state with approved medications for rheumatologic conditions,” said Adalja.
Study co-author Chiara Tassan Din, also from the San Raffaele Hospital, noted that the patients studied were an average age of 62 years, were seriously ill, and had underlying health conditions, putting them at high risk for death from Covid- 19.
“High-dose administration of intravenous anakinra in these patients, who were managed outside the ICU in an environment overwhelmed by the Covid-19 pandemic and with a shortage of ICU resources, appeared to buffer systemic inflammation and was associated with progressive improvement in airway function, “Din said in the statement.
Din noted that viral control has been an approach to Covid-19 treatment until now, but new research suggests that controlling inflammation may be just as important.
Dr. Scott Canna of the University of Pittsburgh Medical Center wrote an editorial that accompanied the findings.
“Given the biological plausibility of anakinra, the drug’s pharmacokinetic and safety profile, and a growing body of positive experience in autoinflammation and cytokine storm, these data are promising and support the prioritization of this approach in planning and enrolling randomized controlled trials, “he wrote.
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