Thursday, 13 Dec 2018

You are here

Anakinra May Attenuate Stroke Outcomes

The journal Stroke has published a trial wherein the use of subcutaneous IL-1Ra (anakinra) was shown to reduce the peripheral inflammatory response in those with an acute ischemic stroke. (Citation source: http://bit.ly/2uoNXEL)

Based on data showing worse stroke outcomes in the face of high IL-6 and C-reactive protein (CRP) levels, researchers sought to assess whether control of inflammation post-CVA would limit cerebral ischemia and improve outcomes after ischemic stroke. 

A double-blind, randomized, placebo-controlled phase 2 trial of subcutaneous anakinra (100 mg given twice daily for 3 days) was initiated within 5 hours of ischemic stroke onset.  The primary outcome was difference in concentration of log(interleukin-6) as area under the curve to day 3. Secondary outcomes included the 3-month stroke outcome assessed by modified Rankin Scale.

A total of 80 patients (mean age, 72 years) were enrolled and 73% received intravenous thrombolytic therapy. Patients were then treated with either placebo or anakinra bid for 3 days.  After 3 days the anakinra patients had significantly lower plasma interleukin-6 (P<0.001) and plasma C-reactive protein (P<0.001) levels.

Despite being well tolerated with no safety concerns, anakinra lowered the modified Rankin Scale, but this was not significant (OR=0.67; (0.29–1.52), P=0.34).

These insufficient 3 mos clinical outcomes may relate to the relatively short duration of anakinra therapy and other factors.  Yet these data suggest the potential interplay between inflammation (IL-1) and tissue damage from thrombotic events. 

These data follow a recent Lancet report of the CANTOS study showing cannakinumab (IL-1 inhibition) significantly lower rate of recurrent cardiovascular events (in high-risk CV patients); and at the same time reduce the rate of total cancer deaths, especially lung cancer. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Kallikrein Inhibitor Lanadelumab Prevents Hereditary Angioedema Attacks

Hereditary angioedema is a rare autosomal dominant disorder due to C1 inhibitor deficiency (type I) or dysfunction (type II) that leads to dysregulated plasma kallikrein activity, excess bradykinin production, and unpredictable potentially life-threatening recurrent angioedema attacks.

FDA Approves Biosimilar Rituximab for NHL, not RA

The U.S. Food and Drug Administration on Wednesday approved Celltrion biosimilar of rituximab called Truxima; previously called CT-P10, now generically labeled as rituximab-abbs. This is the first biosimilar to the Rituxan currently approved to treat non-Hodgkin’s lymphoma. Truxima is not approved for use in rheumatoid arthritis, vasculitis, pemphigus vulgaris or chronic lymphocytic leukemia.

First FDA Approved Drug for HLH

The first drug specifically for primary hemophagocytic lymphohistiocytosis (HLH) was approved today, the FDA announced.

Emapalumab (Gamifant), manufactured by Novimmune SA, may be used in all patients (including newborns and older children) "who have refractory, recurrent, or progressive disease or intolerance with conventional HLH therapy," the FDA said.

Should Immunoglobulins be Monitored with Rituximab Use?

Boston researchers have found that in a large cohort study of patients receiving rituximab (RTX), most were not being monitored for hypogammaglobulinemia, despite the observed significant increase in severe infections and increased mortality in RTX treated patients.

IL-6 for Adult Still's: A New Option?

Some clinical benefits were seen among patients with adult-onset Still's disease treated with tocilizumab (Actemra) in a small clinical trial, but the study's primary endpoint was not met, Japanese researchers reported.