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Endocrine Abstracts (2022) 81 OC1.3 | DOI: 10.1530/endoabs.81.OC1.3

1University Hospital Basel, Division of Endocrinology, Diabetes and Metabolism, Switzerland; 2Kantonsspital Aarau, Medical University Department of Medicine, Aarau, Switzerland; 3Geneva University Hospital, Division of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Genève, Switzerland; 4Geneva University Hospital, Division of General Internal Medicine, Department of Medicine, Genève, Switzerland; 5Centre Hospitalier Universitaire Vaudois, Service d’Endocrinologie Diabète et Métabolisme, Lausanne, Switzerland; 6Centre Hospitalier Universitaire Vaudois, Service of Internal Medicine, Lausanne, Switzerland; 7Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 8Luzerner Kantonsspital, Department of Endocrinology, Luzern, Switzerland; 9Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland; 10University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology, Zürich, Switzerland; 11University of Basel, Department of Clinical Research, Basel, Switzerland; 12University Hospital Basel, University of Basel, Intensive Care Unit, Basel, Switzerland


Background: Patients with type 2 diabetes and overweight have a chronic activation of the innate immune system possibly explaining the increased risk of a hyperinflammatory response and severe COVID-19. We aimed to test whether blockade of interleukin-1β(IL-1β) using canakinumab improves clinical outcome.

Methods: CanCovDia was a multicenter, randomised, double-blind, placebo-controlled trial to assess the efficacy of canakinumab plus standard-of-care compared with placebo plus standard-of-care in patients with type 2 diabetes and a BMI > 25 kg/m2 hospitalised with SARS-CoV2 infection. Patients were randomly assigned 1:1 to a single dose of canakinumab (body weight-adapted dose of 450-750 mg) or placebo intravenously. Canakinumab and placebo were compared on the basis of an unmatched win-ratio approach consisting of length of survival, ventilation, ICU stay and hospitalization. This study is registered with ClinicalTrials.gov, NCT04510493.

Findings: Between October 23, 2020, and May 12, 2021, 116 patients were randomly assigned with 58 in each group. The win-ratio analysis between canakinumab vs placebo was 1·08 (95% CI 0·69-1·69; P=0·72). After four weeks, in the canakinumab group 4 people died (7·0%), 12 were hospitalized for more than 3 weeks (23·5%), and 11 were on ICU (20·0%), vs 7 (12·3%), 16 (28·3%) and 11 patients (21·6%) respectively. Median ventilation time at 29 days was 10 days [IQR 6.0, 16.5] in the canakinumab group and 16 days [IQR 14.0, 23.0] in the placebo group. Glycated haemoglobin A1c (HbA1c) in the canakinumab group after four weeks was 7·40 [6·65, 8·30] vs 7·50 in the placebo group ([6·68, 8·33] P=0·955) despite a lower number of antidiabetics administered in patients treated with canakinumab vs placebo (OR 0·47 [95% CI 0·23-0·95] P=0·03). Median ratio to baseline of endogenous Insulin ( pmol/l) at four weeks was 0.94 [0.59, 1.66] in the canakinumab group vs placebo 0.64 [0.29, 1.44] (OR 2.21 [1.09, 4.48] (P=0.029). Serious adverse events were reported in 13 (11·4%) patients in each group treated with canakinumab and placebo, respectively.

Interpretation: In patients with type 2 diabetes who were hospitalised with COVID-19, treatment with canakinumab in addition to standard-of-care did not result in a significant improvement of the primary composite outcome despite a numerical benefit in survival, ICU and ventilation time. Patients treated with canakinumab required significant less antidiabetic drugs to achieve similar glycaemic control, possibly due to increased insulin production.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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