Patient Selection for Immunomodulation

Emerging evidence on host genetic factors predisposing to exaggerated hyperinflammatory responses may allow individualised therapy selection. The key lesson from MATIS and parallel trials is that patient selection for immunomodulation requires greater precision than a single CRP threshold. A biomarker substudy of pre-randomisation MATIS samples is underway to assess whether immune phenotypes can guide immunomodulator choice. The CRP-only entry criterion of ≥30 mg/L used in MATIS may have been insufficiently specific to identify hyperinflammatory phenotypes most likely to benefit from immunomodulation. MATIS results are expected to inform management of other virally induced multisystemic hyperinflammatory disorders beyond COVID-19.