Expert comments

Comments on this technologies were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Five experts contributed to the development of this briefing.

Level of innovation

All experts acknowledged that cytokine adsorption devices are not new because they have been used for different indications, but their use in treating people with COVID‑19 is novel. All agreed that adsorption technology is not currently widely used in the NHS.

Potential patient impact

Experts acknowledged the technology may result in patient benefits such as increased rate of recovery, reduced complications because of elevated cytokine levels and reduced mortality, but there is no evidence for these possible benefits. One expert said that the evidence base suggests the devices reduce cytokine levels but that it is not clear whether this results in improved clinical outcomes. One believes the technology is a simple, and relatively fast acting and safe treatment that can be repeated.

Potential system impact

Experts said that if the technology is clinically effective then it has the potential to increase intensive care unit capacity, improve patient outcomes and be cost saving, but the evidence is of too low methodological quality to show clinical effectiveness in people with COVID‑19. One expert said that using the technology would result in an increased knowledge in the NHS about alternative therapies such as adsorption devices. Another expert said that using these technologies may reduce the number of biological therapies given, such as plasma transfusions.

General comments

Experts acknowledged that there are pharmacological therapies that are also used to reduce cytokine levels in the blood. However, 1 expert noted that these drugs have additional complications such as neutralising antibodies and other adverse effects. Experts suggested that implementation would be easier with the cartridges that filter whole blood and use extracorporeal circuits such as haemodialysis and haemofiltration because they are more readily available in the NHS than plasma exchange machines or extracorporeal membrane oxygenation (ECMO) machines, which would need significant training for inexperienced users. All experts agree that further research is needed to demonstrate clinical efficacy.