Article Text
Abstract
Background The spread of COVID-19 had a strong impact in north-east Italy especially during 2020 and in the first 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 autoinflammatory diseases, referring to the Autoinflammatory 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), confirmed 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 Undifferentiated Autoinflammatory 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 nasopharyngeal 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 significant (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 inflammasome regulator, may curb the hyperinflammation typical of COVID-19. Given the promising results obtained with anti-IL-1 and colchicine 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.
Disclosure of Interests None declared