Background/Purpose: Coronavirus disease (COVID-19) patients can progress to a state of unregulated inflammation called cytokine storm syndrome (CSS). A multi-disciplinary approach is needed to identify COVID-19 patients at risk of CSS. Therapy with corticosteroids, anti-interleukin-1 (anti IL-1) and anti-interluekin-6 (anti-IL 6) reduce the systemic inflammatory response, which can prevent rapid progression of cytokine mediated diffuse alveolar damage. There is extremely limited literature on the safety and efficacy of biologic immunosuppressive therapy in COVID-19 patients. Till date there are no formal guidelines, as when to initiate immunosuppressive therapy in COVID-19 patients

Methods: Institutional experts from different sub-specialities formed a COVID-19 CSS task force at Montefiore Medical Center, Bronx, NY. Consensus recommendations regarding biologic therapy were made after daily multi-disciplinary virtual conference. This is a single center retrospective observational study, where we describe the baseline characteristics, clinical and laboratory parameters, and the outcome of our COVID-19 CSS consult cohort patients who received biologic immunosuppressive therapy either anti IL-1 and/or anti IL-6.

Results: Between April 4,2020 and May 7,2020, the CSS consult service evaluated a total of 288 patients for possible COVID-19 CSS, out of these 35 patients received biologic immunosuppressive therapy either anti IL-1 and/or anti IL-6. Among these 35 patients 4 patients received the biologic therapy on admission prior to COVID-19 CSS consult task force consultation and the 31 patients received the biologic therapy after the COVID-19 CSS task force consultation. Fifteen patients (83%) received anti IL-1 therapy, 18 patients (51%) received anti-IL6 therapy and 2 patients (6%) received both. Eleven patients (31%) receiving biologic immunosuppressive therapy survived. The patients who survived were younger with a median age of 42 years versus 55 years in the non-survivor group (p=0.04). A higher proportion of patients who survived, had earlier multidisciplinary CSS task force consultation on day 4 ( IQR – 2-12 days) after admission as compared to day 6.5 ( IQR- 3-11 days )in the non-survivor group.

Conclusion: We describe a unique approach from our institution where an earlier multi-disciplinary COVID-19 CSS task force consultation on the COVID-19 patients progressing towards CSS, could help alter the disease course by timely intervention with biologic therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multidisciplinary-timely-approach-to-initiate-immunosuppressive-biologic-therapy-and-improve-covid-19-cytokine-storm-syndrome-outcome/