SARS-COV-2 COURSE and OUTCOME in PATIENTS with SYSTEMIC AUTOINFLAMMATORY DISEASES (SAID) TREATED with IL-1 INHIBITORS and COLCHICINE
Annals of the Rheumatic Diseases
; 81:940, 2022.
Article
in English
| EMBASE | ID: covidwho-2008910
ABSTRACT
Background:
The spread of COVID-19 had a strong impact in north-east Italy especially during 2020 and in the frst months of 2021. Patients affected by rheumatological disorders are at high risk of infections due to immunosuppressant therapies and a clear immunological imbalance. However, some anti-cytokines such as IL-1 inhibitors proved to be effective in curbing the cytokine storm, frequent feature of severe COVID-19.Objectives:
We assessed the SARS-CoV-2 clinical course in 28 patients affected by autoinfammatory diseases, referring to the Autoinfammatory Outpatient Clinic of Padova University;in particular we observed if patients undertaking IL-1 inhibitors (group-1) had a diverse outcome compared to those not on anti-IL-1 drugs (group-2).Methods:
Through telephone or e-mail consultancy, 28 patients (18 females, mean age 39.5±15), confrmed to have contracted COVID-19 between March 2020 and January 2022. Twelve patients (42.8%) were affected by periodic fevers (FMF/TRAPS), 10/28 (35.7%) had Adult-Onset Still's Disease, 3/28 (10.7%) had Undiffer-entiated Autoinfammatory Diseases, while 2/28 (7.1%) were affected by BehÇet Disease and one patient had Schnitzler Syndrome. 12 out of 28 patients (42.8%) were undertaking IL-1 inhibitors;8/28 (28.5%) were in therapy with colchicine;2 patients were in therapy with methotrexate and abatacept respectively, and 6/28 (21.4%) received no therapy. All were diagnosed with COVID-19 after molecular nasopharyn-geal swab performed either for the presence of symptoms or close contact with a positive subject. 5/28 patients had the infection after receiving the second vaccine shot, two after the booster dose. All the others had COVID-19 before the vaccine injection. GraphPad5 was used for statistical analysis and Fisher's test was applied.Results:
COVID-19 clinical course was benign in 27 out of 28 patients (96.4%);a total of 29 infections were counted due to a case of re-infection;2 patients discontinued the therapy;all the others continued their medications (92.8%). Two patients (7.1%) of the entire cohort were hospitalized, one died. Regarding the major symptoms (fever ≥ 38 C°, cough/respiratory or gastro-intestinal symptoms) no difference was noticed between group-1 and group-2 (p=0.449);despite group-1 required less symptomatic therapy than group-2, the difference was not signifcant (p=0.471). Table 1 summarizes the clinical features exhibited by the patients and the therapies undertaken during the infection.Conclusion:
Despite the low sample size, our study is of interest since it proves that the inhibition of IL-1 with both anakinra or canakinumab and the employment of colchicine, an important infammasome regulator, may curb the hyperinfammation typical of COVID-19. Given the promising results obtained with anti-IL-1 and colchi-cine in treating severe COVID-19, it is conceivable a 'protective' role of these drugs in preventing a massive cytokine release. Unsurprisingly, none of our patients but one, had a severe course or fatal outcome after SARS-CoV-2 infection.
abatacept; anakinra; canakinumab; colchicine; endogenous compound; interleukin 1; methotrexate; vaccine; adult; adult onset Still disease; adverse drug reaction; autoinflammatory disease; case report; clinical article; clinical feature; cohort analysis; conference abstract; coronavirus disease 2019; coughing; cytokine release; drug combination; drug therapy; e-mail; employment; fatality; female; fever; gastrointestinal symptom; human; male; nonhuman; outcome assessment; outpatient department; recurrent fever; reinfection; sample size; Schnitzler syndrome; Severe acute respiratory syndrome coronavirus 2; telephone
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Annals of the Rheumatic Diseases
Year:
2022
Document Type:
Article
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