Haibel Hildrun, Poddubnyy Denis, Angermair Stefan, Allers Kristina, Vahldiek Janis L, Schumann Michael, Schneider Thomas
Department of Gastroenterology, Infectiology and Rheumatology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Ther Adv Musculoskelet Dis. 2022 Sep 4;14:1759720X221116405. doi: 10.1177/1759720X221116405. eCollection 2022.
Interleukin (IL)-6 and IL-1 blockade showed beneficial results in patients with severe COVID-19 pneumonia and evidence of cytokine release at the early disease stage. Here, we report outcomes of open-label therapy with a combination of blocking IL-6 with tocilizumab 8 mg/kg up to 800 mg and IL-1 receptor antagonist anakinra 100-300 mg over 3-5 days. Thirty-one adult patients with severe COVID-19 pneumonia and signs of cytokine release, mean age 54 (30-79) years, 5 female, 26 male, and mean symptom duration 6 (3-10) days were treated. Patients with more than 10 days of symptoms, evidence of bacterial infection/elevated procalcitonin and other severe lung diseases were excluded. Computed tomography (CT) scans of the lung were performed initially and after 1 month; inflammatory activity was assessed on a scale 0-25. Twenty-five patients survived without intubation and mechanical lung ventilation, two patients died. C-reactive protein decreased in 19/31 patients to normal ranges. The mean activity CT score decreased from 14 (8-20) to 6 (0-16, = 16). In conclusion, most of our patients recovered fast and sustained, indicating that early interruption of cytokine release might be very effective in preventing patients from mechanical ventilation, death, and long-term damage.
白细胞介素（IL）-6和IL-1阻断疗法在患有严重新型冠状病毒肺炎且在疾病早期有细胞因子释放证据的患者中显示出有益效果。在此，我们报告了开放标签治疗的结果，该治疗采用托珠单抗8 mg/kg（最大800 mg）阻断IL-6与阿那白滞素100 - 300 mg联合使用，持续3 - 5天。31例患有严重新型冠状病毒肺炎且有细胞因子释放迹象的成年患者接受了治疗，平均年龄54（30 - 79）岁，女性5例，男性26例，平均症状持续时间6（3 - 10）天。症状超过10天、有细菌感染/降钙素原升高证据以及其他严重肺部疾病的患者被排除。最初及1个月后进行肺部计算机断层扫描（CT）；炎症活动度按0 - 25分进行评估。25例患者存活且未进行插管和机械通气，2例患者死亡。19/31例患者的C反应蛋白降至正常范围。CT平均活动评分从14（8 - 20）降至6（0 - 16，P = 16）。总之，我们的大多数患者恢复迅速且持久，这表明早期阻断细胞因子释放可能对预防患者进行机械通气、死亡及长期损害非常有效。
