| Autor: |
Della-Torre, Emanuel, Lanzillotta, Marco, Campochiaro, Corrado, Cavalli, Giulio, De Luca, Giacomo, Tomelleri, Alessandro, Boffini, Nicola, De Lorenzo, Rebecca, Ruggeri, Annalisa, Rovere-Querini, Patrizia, Castagna, Antonella, Landoni, Giovanni, Tresoldi, Moreno, Ciceri, Fabio, Zangrillo, Alberto, Dagna, Lorenzo |
| Předmět: |
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| Zdroj: |
Frontiers in Immunology; 4/29/2021, Vol. 11, pN.PAG-N.PAG, 10p |
| Abstrakt: |
Background: Restraining maladaptive inflammation is considered a rationale strategy to treat severe coronavirus disease-19 (COVID-19) but available studies with selective inhibitors of pro-inflammatory cytokines have not provided unequivocal evidence of survival advantage. Late administration is commonly regarded as a major cause of treatment failure but the optimal timing for anti-cytokine therapy initiation in COVID-19 patients has never been clearly established. Objectives: To identify a window of therapeutic opportunity for maximizing the efficacy of interleukin (IL)-1 and IL-6 blockade in COVID-19. Methods: Survival at the longest available follow-up was assessed in severe hyper-inflamed COVID-19 patients treated with anakinra, tocilizumab, sarilumab, or standard of care, stratified according to respiratory impairment at the time of treatment initiation. Results: 107 patients treated with biologics and 103 contemporary patients treated with standard of care were studied. After a median of 106 days of follow-up (range 3-186), treatment with biologics was associated with a significantly higher survival rate compared to standard therapy when initiated in patients with a PaO2/FiO2 ≥ 100 mmHg (p < 0.001). Anakinra reduced mortality also in patients with PaO2/FiO2 < 100 mmHg (p = 0.04). Conclusions: IL-1 and IL-6 blocking therapies are more likely to provide survival advantage in hyper-inflamed COVID-19 patients when initiated before the establishment of severe respiratory failure. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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