Anakinra

In the initial period of the pandemic, a few thousand cases (March 2020) snowballed into whopping 10 million+ cases on record (December 2020). The spread of SARS-CoV-2 in India is a lot more rampant and daunting than what has been observed in other countries. Despite a countrywide lockdown and curfews, the numbers are not ceasing to rise.

India is currently the second-worst affected nation by COVID-19. Looking at country’s current scenario, the situation calls for the urgent steps to be undertaken for a better hold of the crisis at larger scale. The poor or no effect of currently available antiviral drugs (Remdesivir, Hydroxychloroquine, Lopinavir) and Interferon regimens makes situations alarming. As per newer studies, the surge in daily new infections is expected to rise. In a severe form of COVID-19, patient needs to be kept on life support system. This usually results in financial burden on the patient’s family. Also, inadequate availability of these systems in the country makes the treatment of severe COVID-19 difficult. All these factors lead to a search for an effective and safe therapeutic for the moderate to severely affected COVID-19 patients.

Initial reports of off-label use of Anakinra in severe COVID-19 patients have created a glimmer of hope. Very high doses of this therapeutic drug are proven to be safe in both infants and adults. With published literature of its safety and efficacy, and with more than twelve ongoing clinical trials on Anakinra, it stands out as a promising therapeutic biomolecule in this pandemic.

Mechanism of action
Anakinra is a recombinant form of IL-1Ra (Interleukin-1 Receptor antagonist) that is used mainly in the treatment of rheumatoid arthritis. Interleukin-1 causes inflammation in the arthritis patients, which is controlled by anakinra treatment.

The anakinra molecules compete with IL-1 molecules and bind to IL-1 receptors on the cell surface and, as a result, the signal of IL-1 is blocked. Since the initiator signal is blocked, further amplification of this signal into the cellular cascade of cytokine release is prevented. This alleviates the symptoms of the hyper inflammation and halves the criticality of the disease. The cascade of IL-1 release & nature inflammatory response is similar to the cytokine storm syndrome in severe COVID-19.

Anakinra in COVID 19
Interleukin-1 plays a key role in the hyper-inflammatory response elicited during advanced stages of the disease. Anakinra, being an IL-1 antagonist, was tested in moderate to severe patients of COVID-19. The treatment has proven to be effective as more than 50% of the patients were able to get rid of the ventilators and shown to have improved blood oxygen levels. There was a significant reduction in the levels of inflammation biomarkers.