Cytokine inhibitors in COVID-19: looking back to move forward

摘要

I n this issue of Minerva Anestesiologica, Monti et al.1 describe their experiences of using immunomodulatory agents at the beginning of the COVID-19 pandemic in early 2020. Their retrospective, single center study showed that anakinra, an interleukin-1 receptor (IL-1R) inhibitor was associated with benefit, however tocilizumab, an IL-6 receptor (IL-6-R) antagonist was potentially associated with harm. They have very carefully analyzed their dataset (N.=61) and used appropriate Bayesian methods to try to understand if any of the treatment options could be beneficial for their patients, who were all mechanically ventilated and all had viral infection induced ARDS. Some of their observations seem to stand the test of time, whilst others, especially the hint for worse outcome using tocilizumab in the critically ill patients, seems to be counterintuitive, especially after reading the positive results of tocilizumab treatment in the two largest randomized controlled trials (RCT) on this topic.