IL-1 antagonists in type 2 diabetes and Covid-19
Treatment with canakinumab in people with type 2 diabetes infected with Covid-19 did not lead to any significant improvement.
Obesity and obesity-associated type 2 diabetes are risk factors for a severe case of Covid-19. The messenger substance interleukin-1beta (IL-1β) plays a potentially important role in this. Production of this substance is stimulated not only by diabetes, but also by a coronavirus infection. IL-1 antagonists have a positive effect on diabetes and alleviate various symptoms. This was the impetus for the national CanCovDia study by Marc Donath and his team at the University of Basel.
In this study, the researchers investigated whether blocking IL-1β would have a positive effect on the course of a Covid-19 infection. IL-1β activates the immune system, triggering an inflammatory response. With a combination of diabetes and Covid-19, this could result in hyperinflammation and thus lead to a severe case. The criteria for inclusion in the study were type-2 diabetes and a BMI over 25. In addition to the standard treatment, the participants received either an intravenous dose of canakinumab or a placebo. The mortality and hospitalisation rates were compared, as well as the frequency of ventilation and ICU admissions.
After one month, no significant differences were measured between the groups for the defined parameters. However, treatment with canakinumab had a positive effect on the mortality rate, ICU stays and ventilation time. In addition, patients treated with canakinumab needed considerably fewer antidiabetics to achieve a comparable blood glucose level, which may be due to an increase in insulin production. Furthermore, canakinumab was linked with a sustained decrease in systemic inflammation.
Canakinumab in patients with COVID-19 and type 2 diabetes – A multicentre, randomised, double-blind, placebo-controlled trial