Efficacy of canakinumab in mild or severe COVID‐19 pneumonia

Abstract

Background Clinicians all around the world are currently experiencing a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Several therapeutic strategies have been used until now but, to date, there is no specific therapy to treat SARS‐CoV‐2 infection. In this study, we used canakinumab, a human monoclonal antibody targeting interleukin‐1 beta to improve respiratory function and laboratory parameters compared with standard therapy (hydroxycloroquine plus lopinavir/ritonavir). Methods We enrolled 34 patients with mild or severe non intensive care unit (ICU) coronavirus disease 2019 (COVID‐19): 17 patients treated with standard therapy and 17 patients treated with a subcutaneous single dose of canakinumab 300 mg. We collected data about oxygen supports and laboratory parameters such as inflammation indices and hemogasanalysis. We compared the data collected before the administration of canakinumab (T0), 3 days after T0 (T1) and 7 days after T0 (T2) with the same data from patients taking the standard therapy. Results We observed a reduction in inflammation indices and a significant and rapid increase in P/F ratio in canakinumab group, with improvement of 60.3% after the administration. We reported a significant reduction in oxygen flow in patients treated with canakinumab (−28.6% at T1 vs. T0 and −40.0% at T2 vs. T1). Conversely, the standard group increased the supply of high oxygen at T1 versus T0 (+66.7%), but reduced oxygen flows at T2 versus T1 (−40.0%). Conclusion In hospitalized adult patients with mild or severe non ICU COVID‐19, canakinumab could be a valid therapeutic option. Canakinumab therapy causes rapid and long‐lasting improvement in oxygenation levels in the absence of any severe adverse events.

The signal pathways and treatment of cytokine storm in COVID-19

“…The results showed that canakinumab treatment significantly increased the PaO 2 /FiO 2 ratio and reduced inflammatory indices. 263 These two studies suggest that canakinumab treatment may have therapeutic potentials in non-ICU patients with mild or severe COVID-19. Several other reports have also evaluated the administration of canakinumab in COVID-19, 264 – 266 and six clinical trials are currently registered in ClinicalTrials.gov (NCT04348448, NCT04476706, NCT04362813, NCT04365153, NCT04510493, NCT04278404).…”

COVID19-associated cardiomyocyte dysfunction, arrhythmias and the effect of Canakinumab

“…Arrhythmic Ca 2+ release was observed especially after long-term exposure to COVID19 serum. In the present study, the IL-1β blocker Canakinumab was used to potentially mitigate these in-vitro effects, as Canakinumab has been shown to improve outcomes in mild or severe COVID19 pneumonia in early clinical trials with limited numbers of patients [ 33 ]. However, chronic co-incubation with Canakinumab had no beneficial effect on cellular Ca 2+ signaling during excitation-contraction coupling or on electrical dysfunction in our iPS-CM model.…”

Clonal hematopoiesis in patients with Covid‐19 is stable and not linked to an aggravated clinical course

“…Of interest, therapy with a human monoclonal antibody targeting IL-1β (canakinumab) in Covid-19 has been reported to cause a reduction in inflammation, and an improved respiratory function with reduced oxygen need, implicating a potential role of IL-1β in severe Covid-19. 9 However, a randomized trial utilizing another IL-1β neutralizing drug (Anakinra) did not show any benefit. 10 Thus, the pathogenic role of IL-1β for severe Covid-19 as well as therapeutic neutralization as potential treatment needs to be further determined.…”