COVID-19 Hyperinflammatory Syndrome

Tocilizumab (an IL-6 inhibitor) was found to reduce mortality by 15% versus usual care in the RECOVERY trial. Severe COVID-19 pneumonia is characterised by respiratory and multiorgan failure in the context of marked systemic inflammation and elevated thrombotic risk. The balance between permitting adequate antiviral immune responses and preventing hyperinflammatory escalation represents a narrow, poorly defined therapeutic window. The MATIS investigators hypothesised a narrow early therapeutic window in which inflammatory signal inhibitors could interrupt COVID-19 hyperinflammatory syndrome before acute lung injury progresses irreversibly. Elevated circulating inflammatory molecules are associated with poor prognosis and in a subset of patients drive acute lung injury leading to organ failure and death.