COVID-19 cytokine storm: mavrilimumab shows treatment potential

  • De Luca G & al
  • Lancet Rheumatol
  • 17 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Mavrilimumab shows promise for early clinical improvements in respiratory outcomes for patients hospitalized with pneumonia and hyperinflammation because of COVID-19. 

Why this matters

  • Editorial: randomized controlled trials are needed to establish risk/benefit balance of targeting/timing of anti-granulocyte-macrophage colony-stimulating factor. 
  • Targeted immunomodulation may reduce progression to acute respiratory distress syndrome and mortality in patients with hyperinflammation and COVID-19. 

Key results

  • Patients: 13 on mavrilimumab and 26 receiving standard care.
    • Mavrilimumab group: median age, 57 (interquartile range [IQR], 52-58) years; 92% (12) men. 
    • Standard-care group: median age, 57 (IQR, 53-67) years; 65% (17) men.
  • Mortality:
    • Mavrilimumab: 0%.
    • Standard care: 27% (P=.086).
      • 86% of deaths occurred in week 1; the rest on day 8.
  • Clinical improvement >2 points:
    • Mavrilimumab: 100%.
    • Standard care: 65% (P=.030).
    • Reached in a median (IQR) of:
      • Mavrilimumab: 8 (5-11) days. 
      • Standard care: 19 (11 to >28) days (P=.0001).
  • Time to hospital discharge (medians; IQRs):
    • Mavrilimumab: 10 (9-12) days. 
    • Standard care: 20 (12 to >28) days (P=.0030).
  • >25% PaO2:FiO2 improvement:
    • Mavrilimumab: 100%.
    • Standard care: 65%. 
  • CRP reduction of >75% postbaseline:
    • Mavrilimumab: 85%.
    • Standard care: 44% (P=.035).
  • Fever resolution (medians; IQRs): 
    • Mavrilimumab: 1 (1-2) days.
    • Standard care: 7 (3 to >14) days (P=.0093).

Study design

  • Single-center, prospective cohort study. 
  • Funding: San Raffaele Scientific Institute (Milan).

Limitations

  • Selection bias, placebo effect.
  • Short follow-up.