corona virus-Covid19

Timing Matters: Anti-inflammatory Drugs for COVID-19 Work Best When Given Early Interview with:

Pranay Sinha, MD Research Fellow Section of Infectious Diseases Boston University School of Medicine

Dr. Sinha

Pranay Sinha, MD
Research Fellow
Section of Infectious Diseases
Boston University School of Medicine What is the background for this study?

Response: In the early days of the COVID-19  pandemic there were no evidence-based treatments for severely ill patients infected with this virus. We formed an interdisciplinary group of physicians from departments of adult and pediatric infectious diseases, rheumatology, and pulmonary/critical care as well as clinical pharmacy specialists. Given some promising data from China, we instituted treatment with off-label IL-6 receptor inhibitors (tocilizumab and sarilumab). The rationale was to mitigate the exuberant immune response observed in some patients infected with SARS-CoV-2 (also called cytokine storm or cytokine release syndrome).

Quite quickly, we started noticing that giving the drug to our sickest patients wasn’t eliciting dramatic improvement. We reasoned that by the time patients were severely ill and requiring ventilators, the damage to their lungs from the cytokine storm had already taken place. It was like closing the barn door after the horse had already bolted. What are the main findings?

Response: We started to give the drugs earlier and iteratively assessed our rates of death, intubation, and discharge. It became evident that giving the drug earlier was beneficial. Indeed, the mortality rate (2.7%) we report in our group of severely ill COVID-19 patients who received early treatment with tocilizumb or sarilumab are among the lowest in the literature. We also did not find an inordinate secondary infection rate in our cohort. What should readers take away from your report? 

Response: Some major takeaways are:

  1. The timing of immunomodulatory drugs being tested for COVID-19 disease matters and this should be taken into consideration when both taking care of patients and interpreting data from clinical trials
  2. Multidisciplinary collaboration is crucial as we figure out how to minimize the loss of life from COVID-19.
  3. It is possible to do good research during a pandemic.
  4. While randomized controlled trials are crucial to make definitive conclusions, there is a clear role for well-designed observational research while awaiting data. The WHO’s monitored emergency use of unregistered and investigational interventions framework can be a helpful guide. What recommendations do you have for future research as a result of this work?

Response: Future studies should control for the timing of IL6ri or other immunomodulators as they analyze the effectiveness of the drugs. Is there anything else you would like to add?

Response: Some of the early trials of sarilumab and tocilizumab are suggesting no benefit. We are eager to see the publications to understand the time of drug administration, and its relationship to the outcome of interest.


Early administration of Interleukin-6 inhibitors for patients with severe Covid-19 disease is associated with decreased intubation, reduced mortality, and increased discharge
Sinha, Pranay et al.
International Journal of Infectious Diseases, Volume 0, Issue 0



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Last Updated on August 5, 2020 by Marie Benz MD FAAD