Immunomodulatori come anakinra, sarilumab, siltuximab e tocilizumab nel trattamento al COVID-19: si stanno accumulando prove di una risposta immunitaria eccessivamente attivata nella forma più grave di COVID-19, con diversi studi che esplorano il ruolo terapeutico dell’immunomodulazione.

Revisione sistematica e meta-analisi dei dati: Immunomodulatori nel trattamento COVID-19

Attraverso una revisione sistematica e una meta-analisi, lo studio che presentiamo ha valutato l’efficacia di specifici inibitori dell’interleuchina per il trattamento della COVID-19.

I database elettronici utilizzati sono stati ricercati il 7 gennaio 2021 per identificare gli studi sugli agenti immunomodulatori (anakinra, sarilumab, siltuximab e tocilizumab) per il trattamento della COVID-19.

Gli esiti primari erano la gravità su una scala ordinale misurata al 15° giorno dall’intervento e i giorni alla dimissione dall’ospedale.

Gli endpoint secondari chiave includevano la mortalità complessiva.

Sono stati inclusi 71 studi per un totale di 22 058 pazienti, 6 erano studi randomizzati.

La maggior parte degli studi ha esplorato i risultati nei pazienti che hanno ricevuto tocilizumab (60/71).

Negli studi prospettici, il tocilizumab è stato associato a una migliore sopravvivenza non aggiustata (rapporto di rischio 0,83, 95% CI da 0,72 a 0,96, I2=0,0%), ma il beneficio conclusivo non è stato dimostrato per altri risultati.

Negli studi retrospettivi, il tocilizumab è stato associato a esiti meno gravi su una scala ordinale (OR generalizzato 1,34, 95% CI da 1,10 a 1,64, I2=98%) e rischio di mortalità aggiustato (HR 0,52, 95% CI da 0,41 a 0,66, I2=76,6%).

La differenza media nella durata del ricovero è stata di 0,36 giorni (95% CI da -0,07 a 0,80, I2=93,8%).

I risultati dello studio su immunomodulatori nel trattamento COVID-19

C’era una sostanziale eterogeneità negli studi retrospettivi e le stime dovrebbero essere interpretate con cautela.

Altri agenti immunomodulatori hanno mostrato effetti simili a quelli del Tocilizumab, ma dati insufficienti hanno precluso una meta-analisi per agente.

Il tocilizumab è stato associato a un rischio relativo più basso di mortalità negli studi prospettici, ma gli effetti sono stati inconcludenti per altri risultati.

L’attuale evidenza per l’efficacia di anakinra, siltuximab o sarilumab in COVID-19 è insufficiente, con ulteriori studi urgentemente necessari per risultati conclusivi.

Immunomodulatori nel trattamento COVID-19

thoraxjnl-2020-215266.full (1) COMPLETA

Per approfondire:

Covid-19 e terapia immunosoppressiva nei pazienti con trapianto di fegato: lo studio europeo coordinato dal Niguarda

Covid-19 e bambini con problemi renali: uno studio del Policlinico di Milano su immunodepressione pediatrica

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