TOSUCCESSFUL TREATMENT OF SEVERE COVID-19 PNEUMONIA AND CYTOKINE RELEASE WITH SIMULTANEOUS TOCILIZUMAB AND ANAKINRA WITH ONE-MONTH FOLLOW-UP
Authors: H. Haibel et al.
Interleukin (IL)-6 and IL-1 blockade alone showed contradictory results in severe COVID-19 pneumonia that might be related to the differences in patient populations (early vs. late stage) and to the fact that blockade of just one cytokine might be not sufficient against the cytokine storm.
In this open-label study treatment with a combination of the IL-6 receptor blocker tocilizumab and and the IL-1 receptor antagonist anakinra in patients with early and severe COVID-19 pneumonia with evidence of cytokine release was examined. 15 patients with severe to critical COVID-19 infection associated pneumonia and cytokine release, requiring oxygen supplementation and evidence of rapid deterioration and decrease of oxygen saturation to ≤ 95% were treated with tocilizumab 8 mg/kg up to 800 mg intravenously and anakinra 100 to 300 mg for 3 to 5 days. None of the treated patients needed intubation and mechanic ventilation, none of the patients died. Fife patients did not need to be referred to the intensive care unit at all, while 9 patients received non-invasive ventilation and high-flow nasal oxygen support. Chronic fibrotic pulmonary changes were not seen in any patient after 1 month. One patient experienced lower abdominal pain, urinary tract infection, gastrointestinal bleeding due to antrum ulcers Forrest III, in another patient atrial fibrillation, urinary tract infection and apoplexy were observed.
In this case series all patients with severe COVID-19 pneumonia and cytokine release treated with the combination of tocilizumab and anakinra recovered fast and sustained without major infectious side effects, indicating that early interruption of cytokine release might be very effective and safe in preventing patients from mechanical ventilation, death and long-term damage. Since Interleukin (IL)-6 and IL-1 blockade alone showed contradictory results in severe COVID-19 pneumonia the combination of both seems to be more effective.