EFFECTIVENESS OF INTERLEUKIN-1 AND INTERLEUKIN-6 INHIBITION COMPARED TO STANDARD MANAGEMENT IN PATIENTS WITH COVID-19 AND HYPERINFLAMMATION: A COHORT STUDY

Session Type
PLENARY SESSIONS
Date
28.05.2021, Friday
Session Time
12:00 - 14:00
Room
PLENARY HALL
Lecture Time
13:10 - 13:20
Presenter
  • Giulio Cavalli, Italy
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Abstract

Background and Aims

Patients with severe COVID-19 develop a life-threatening hyper-inflammatory response to the virus. Treatment with interleukin (IL)-1 or IL-6 inhibitors has been used to treat this patient population, but the comparative effectiveness of these different strategies remains undetermined.

Methods

Retrospective cohort study of in-hospital patients with COVID-19, respiratory insufficiency, and hyperinflammation, defined as serum C-reactive protein (CRP) ≥100 mg/L and/or ferritin ≥900 ng/ml. The primary endpoint was survival; secondary endpoint was a composite of death or mechanical ventilation. Multivariable Cox regression analysis and interaction tests were conducted.

Results

Of 392 included patients, 275 did not receive IL inhibitors, 62 received the IL-1 inhibitor anakinra, and 55 received an IL-6 inhibitor (tocilizumab, n=29; sarilumab, n=26). At multivariable analysis, patients treated with IL-1 inhibition, but not with IL-6 inhibition, had a significantly reduced mortality risk compared to patients who did not receive IL inhibitors (Hazard Ratios 0.45; 95% CI 0.20-0.99, p=0.04, and 0.90; 95% CI 0.41-1.97; p=0.8, respectively). At interaction tests IL-6 inhibition was effective in a subgroup of patients with markedly high CRP levels, whereas both IL-1 and IL-6 inhibition were more effective in patients with low LDH levels.

Conclusions

IL-1 inhibition, but not IL-6 inhibition, was associated with a significant reduction of mortality in hospitalized patients with COVID-19 and hyperinflammation. IL-6 inhibition was effective in a subgroup of patients with markedly high CRP levels, whereas both IL-1 and IL-6 inhibition were more effective in patients with low LDH levels.

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