08 May Repurposed Rheumatology Drug May Reduce Inflammation in COVID-19 Infection

MedicalResearch.com Interview with:

Dr. Cavalli

Dr. Giulio Cavalli MD PhD &

Prof. Dagna

Prof. Lorenzo Dagna MD FACP

Ospedale San Raffaele and
Vita-Salute San Raffaele University
Milan, Italy

MedicalResearch.com: What is the background for this study?

Response: Upon encountering pathogens, our immune system produces pro-inflammatory mediators, called cytokines. Cytokines activate cells from the immune system. In most people, production of cytokines is an appropriate and protective response to infection. However, some individuals develop excessive and detrimental inflammatory responses, which are even more harmful than the pathogen itself to the host organism.

We hypothesized that some patients with COVID-19 might develop excessive and detrimental inflammation, and that treatment with anti-inflammatory agents might be beneficial in this population.

Anakinra is an inhibitor of the pro-inflammatory molecule interleukin 1 (IL-1). It was originally marketed for the treatment of rheumatoid arthritis, but is now mostly used to treat a variety of pediatric inflammatory diseases.

MedicalResearch.com: What are the main findings? 

Response: In extremely severe patients with COVID-19 and respiratory failure, treatment with high-dose intravenous anakinra appears to have quenched inflammation, improved respiratory function, and reduced death and need for mechanical ventilation. 

MedicalResearch.com: What should readers take away from your report?

Response: Aside from anti-viral therapies, modulation of inappropriate inflammatory responses is key to reduce the social and individual burden of the COVID-19 pandemic. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Caution is advisable in interpreting our findings, because they are not the result of a properly organized, controlled investigation. Italy was the first country outside of China to be swamped by this pandemic, so we did not have time to organize a properly controlled and randomized study: we privileged access to a safe and potentially useful medication over study design. Our results should be confirmed in controlled studies, and these studies should be organized urgently, as a second wave of infections can be expected in several countries.

MedicalResearch.com: Is there anything else you would like to add?

Response: We are experts in IL-1 and cytokines, and we have received consultation fees from some companies interested in making or using therapies blocking cytokines. This includes the manufacturers of anakinra, as well as others. However, this investigation was not sponsored or backed up by any company: it was a completely independent investigation, based entirely on our ideas and carried out with our own funding 

Citation:

Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study
Cavalli, Giulio et al.
The Lancet Rheumatology, Volume 0, Issue 0

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Last Updated on May 12, 2020 by Marie Benz MD FAAD