Hospitalized Black/African-American patients with COVID-19, and a baseline C-reactive protein (CRP) 500 patients were Black/African-American.
In the SCCM abstract, Burger’s group explained that “Black/African Americans (B/AA) are twice as likely as Whites to develop COVID-19, possibly due to disparities in healthcare access and genetics. Mutations in the angiotensin converting enzyme gene enabling greater SARS-CoV-2 replication may be overexpressed in B/AAs leading to increased viral load, morbidity, hospitalizations, and mortality.”
Hyun Ah Yoon, MD, of Albert Einstein School of Medicine in New York City, called the findings “interesting” and “hypothesis-generating,” but cautioned that “it is an exploratory analysis with a small sample size, and wide confidence intervals suggesting that there is an uncertainty with the estimate.”
Yoon, who was not involved in LIVE-AIR, pointed out to MedPage Today that the data do not “provide precise representation of the effect in the population. It is difficult to say that it is a real effect, and it needs to be validated in a larger sample size.”
She theorized that, if the effect is real, African-American patients may be younger “due to difficulty with early access to healthcare or higher comorbid conditions such as hypertension, diabetes, or obesity. In general, we see fewer younger individuals hospitalized unless they are very sick.”
But there is a significant need in general for new Mab treatments for COVID-19, Yoon stated. Interleukin-6 (IL-6) receptor-blocking Mabs, such as tocilizumab (Actemra) or sarilumab (Kevzara), are used with corticosteroids in critically ill patients with poor prognoses, she said, and the JAK 1/2 inhibitor baricitinib (Olumiant) is recommended for patients who can’t tolerate corticosteroids.
“There is a gap in treatment options that can halt the disease progression between the early viral replicatory and hyperinflammatory phase. We need better treatment options to prevent patients progressing to meet the criteria for IL-6 inhibitors,” she said.
Yoon said LIVE-AIR results are promising as the “trial suggests that lenzilumab may have a role in patients requiring low-flow oxygen, which is a stage earlier than when we typically use the IL-6 inhibitors. This makes sense as GM-CSF is a more upstream target in the inflammatory cascade, and control of it may theoretically allow better and earlier control of cytokine storms.”
“The findings may…have important clinical implications, especially now in the vaccine era when patients may come in with milder disease and/or individual awareness of COVID-19 has heightened, and may seek care earlier if infected, which will give the clinicians the opportunity for earlier intervention,” she noted, adding that another subgroup analysis by LIVE-AIR investigators found that patients ages