- Anakinra, used initially in rheumatoid arthritis, has been tested on patients with severe forms of Covid-19 within the Paris Saint-Joseph Hospital Group.
- This treatment shows "encouraging" results.
- A ray of hope confirmed by a study published in the scientific journal The Lancet Rheumatology .
Since the start of the coronavirus pandemic, doctors and researchers around the world have been working hard to find an effective treatment for Covid-19. After the endless controversy over hydroxychloroquine, a drug, anakinra, today gives "encouraging" results in the management of severe forms of coronavirus, reducing the risk of death and the need to be put on a ventilator in intensive care, according to a French study conducted within the Paris Saint-Joseph Hospital Group (GHPSJ).
"The significant reduction in mortality associated with the use of anakinra for Covid-19 in this study is encouraging in these difficult times," writes rheumatologist Randy Cron of the University of Alabama (Birmingham) in a comment. , United States) in the trade journal The Lancet Rheumatology , where the study appears. He underlines the "favorable safety profile" of this drug.
What is anakinra and in what pathologies is it initially used?
Known by rheumatologists, anakinra is an immunomodulatory drug, that is to say that it has the ability to influence the reactions of the immune system. It is initially used for the treatment of chronic inflammatory diseases like rheumatoid arthritis, "with an excellent tolerance profile," emphasize the researchers of the GHPSJ. The choice of anakinra was imposed after multidisciplinary meetings involving rheumatologists, pulmonologists, pharmacists and emergency physicians ”.
What results has Covid's anakinra treatment for patients given?
Within the framework of this trial including a group on anakinra and a reference group, the medical team of the GHPSJ administered for ten days, by subcutaneous injection, anakinra (marketed under the name "Kineret") at 52 patients with a severe form of Covid-19. A therapeutic approach which has enabled a “statistically significant reduction in the risk of death and of going into intensive care for respiratory assistance by mechanical ventilation”.
Thus, a quarter of the patients treated with anakinra have been transferred to intensive care or have died. In the control group that did not receive this biotherapy, almost 73% of the patients experienced such an outcome. This comparison group consisted of 44 patients who had also been managed by the GHPSJ. In the anakinra group, a rapid decrease in oxygen requirements was also observed after seven days of treatment. "In the absence of access to therapeutic trials including immunomodulatory drugs for our patients, the decision to offer anakinra, according to severity criteria decided in a consensual and a priori manner, quickly changed the face of the disease indoors ", explains Professor Jean-Jacques Mourad, co-signer of the study, for whom" the benefit was "palpable" on a daily basis ".
By what mechanism does this treatment work on the most serious Covid patients?
Anakinra is intended to counter the "cytokine storm", an uncontrolled inflammatory reaction implicated in severe forms of Covid-19, and which leads to acute respiratory distress syndrome (ARDS). As a result, the lungs do not supply enough oxygen to the vital organs. The patient should be placed on artificial respiration.
In practice, the anakinra targets and blocks one of the cytokines involved in this "inflammatory storm": interleukin-1 (IL-1). The researchers were therefore interested in this molecule for "its mechanism of action which seemed to respond to the pathophysiology of the cytokine storm", but also "because of its kinetics of rapid action, adapted to these clinical forms of evolution Ultra fast ".
"The results of our study suggest that anakinra is an effective treatment in the hyper-inflammatory phase of Covid-19, a situation that carries a high risk of transfer to an intensive care setting," comments Dr. Gilles Hayem, head of the department. of rheumatology at Saint-Joseph hospital.
Where is the scientific research on the use of this drug in the treatment of severe forms of Covid-19?
"There are currently a dozen clinical trials exploring the blockage of cytokine IL-1 associated with inflammatory storm syndrome Covid-19," writes Dr. Randy Cron in The Lancet Rheumatology , for whom "this study provides evidence the strongest evidence to date that anakinra can benefit patients with cytokine storm syndrome associated with Covid-19. Pending the results of controlled trials, the anakinra gives hope to those who are seriously affected by the Covid-19, "he said. "At this stage, we are convinced that this treatment should be tested on a larger number of patients hospitalized in the severe phase of Covid-19," said Dr. Gilles Hayem.
For its part, the AP-HP launched in March CORIMUNO-19, a large-scale study allowing the rapid and simultaneous randomized controlled trials of drugs, especially immunomodulatory drugs, in hospitalized patients for Covid-19 infection. The objective is in particular to determine if some of these molecules make it possible to prevent patients with moderate or severe impairment from needing resuscitation and, in patients in intensive care, to accelerate their exit from intensive care. In this context, a few patients received anakinra, including one at the Diaconesses Croix Saint-Simon Hospital Group in Paris.
And it's not the only drug used in the treatment of rheumatoid arthritis that interests doctors. AP-HP studies on tocilizumab, also prescribed for rheumatoid arthritis, have also shown encouraging results.
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